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Canada’sFoodGuide-CMCResponses(FINAL–2017AU12)Canada’sFoodGuideConsultation:ProfessionalsandOrganisationsHealthCanadaisrevisingCanada’sFoodGuidetostrengthenitsrecommendationsforhealthyeating.Inthefallof2016,weaskedCanadianswhattheyneedandexpectfromarevisedCanada’sFoodGuide.TheWhatWeHeardReportsummarizesthealmost20,000responseswereceived.We’veusedthisinputtohelpdeveloptherecommendationsforhealthyeating,andtoidentifywaystoimprovehowwecommunicatetobettermeettheneedsofdifferentaudiences.Nowweneedyourinputonthenewhealthyeatingrecommendations.Oncewehearfromyouthroughthisonlineconsultation,yourinputwillhelpustofinalizeourrecommendationsanddevelopthemintoconsumermessages,tools,andresources.AnewsuiteofCanada’sFoodGuideresourceswillberolledoutbeginninginearly2018.Thankyoufortakingpart!Thisistheprint-versionoftheeWorkbookcomponentoftheconsultation.Forfurtherinformation,tosubmityourresponsesdirectlyonlineandtoparticipateintheonlinediscussionforum,pleasevisithttp://www.foodguideconsultation.ca.ProfilePleasetellusaboutyourself.ThishelpsHealthCanadatoknowifourconsultationhasmetourgoalofbeingbroad,transparentandinclusive.Wewillnotshareyourdetailsorusethemforanyotherpurposethantogiveyouupdatesonthisconsultationprocess.Thedatawegatherforanalyzingfeedbackwillneveridentifyindividualpeople.1.Pleasechoosewhatbestdescribesyou.Areyougivingusyourfeedback:.Onbehalfofanorganization?.Assomeonewhocaresabouthealtheatingrecommendationsforyou,yourfamily,orfriends?.Asaprofessionalwhouseshealthyeatingrecommendationsinyourwork?.Iprefernottodisclose.2.Province/Territory.Alberta.BritishColumbia.Manitoba.NewBrunswick.NewfoundlandandLabrador.NorthwestTerritories.NovaScotia.Nunavut.Ontario.PrinceEdwardIsland

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.Quebec

.Saskatchewan

.Yukon

.Prefernottodisclose3.Selectthesectorinwhichyouoryourorganisationworks:.Government.Foodandbeverageindustry(forexample,agriculture,foodproducers,foodretailers,fooddistributors,hospitality).Schoolsanddaycares.Hospitalsandotherhealthcarefacilities.Researchinanacademicsetting.Privatepracticeorconsulting.Healthandnutritionorganizations.Sports,athletics,andfitness.OtherFoodprocessingindustryassociation.Prefernottodisclose4.Whatisyouroryourorganization’smaininterestinhealthyeatingrecommendations?.Forprogramdesign.Todeveloppoliciesandguidelines.Fortoolandresourcedevelopment.Forfoodproductdevelopmentormarketing.Forin-servicetrainingandtrainingtrainers.Forindividualnutritionalcounsellingandassessment.Forgroupeducation(forexample,inschoolsorthecommunity).Forassessmentofeatinghabitsinaresearchormonitoringsetting.Forgeneralhealthpromotion.Other________________________________.Prefernottodisclose5.Howoftenyouoryourorganizationworkwithoneormoreofthefollowingclientgroups? OlderadultsChildrenoryouthIndigenouspeoplesLow-incomeearnersAlways Often X X X XSometimesRarelyNeverPrefernottodisclose

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SummaryBasedontheavailableevidence,HealthCanadahastranslatedthescienceonfoodandhealthintoevidence-informedGuidingPrinciplesandRecommendationsforapplicationintheCanadiancontext(Table1).TheGuidingPrinciplesandRecommendationsprovideafoundationforhealthyeatingthatpromoteshealthandreducestheriskofnutrition-relatedchronicdisease.HealthCanadarecognizesthatCanadiansmayoccasionallyhavefoodsandbeveragesoutsidetheserecommendations;lesshealthychoiceshighinsodium,sugars,orsaturatedfatwillbeconsumedattimes.Whatmattersmostiswhatpeopleeatonaregularbasis.Individualswithspecialdietaryrequirementsmayneedadditionalguidancefromahealthcareprofessional.Table1:ProposedGuidingPrinciples,RecommendationsandConsiderationsGuidingPrinciplesandRecommendationsGuidingPrinciple1:Avarietyofnutritiousfoodsandbeveragesarethefoundationforhealthyeating.HealthCanadarecommends:.Regularintakeofvegetables,fruit,wholegrainsandprotein-richfoods,especiallyplant-basedsourcesofprotein.Inclusionoffoodsthatcontainmostlyunsaturatedfat,insteadoffoodsthatcontainmostlysaturatedfat.RegularintakeofwaterGuidingPrinciple2:Processedorpreparedfoodsandbeverageshighinsodium,sugarsorsaturatedfatunderminehealthyeating.HealthCanadarecommends:.Limitedintakeofprocessedorpreparedfoodshighinsodium,sugarsorsaturatedfat.AvoidanceofprocessedorpreparedbeverageshighinsugarsGuidingPrinciple3:Knowledgeandskillsareneededtonavigatethecomplexfoodenvironmentandsupporthealthyeating.HealthCanadarecommends:.Selectingnutritiousfoodswhenshoppingoreatingout.Planningandpreparinghealthymealsandsnacks.SharingmealswithfamilyandfriendswheneverpossibleConsiderations:.Determinantsofhealth.Culturaldiversity.Environment

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GuidingPrinciple1Basedontheavailableevidence,HealthCanadaisproposingthefollowingGuidingprincipleandRecommendationstofocusontheregularintakeofnutritiousfoodsasthefoundationforhealthyeating.GuidingPrinciple1:Avarietyofnutritiousfoodsandbeveragesarethefoundationforhealthyeating.HealthCanadarecommends:.Regularintakeofvegetables,fruit,wholegrainsandprotein-richfoods*-especiallyplant-basedsourcesofprotein.Inclusionoffoodsthatcontainmostlyunsaturatedfat,insteadoffoodsthatcontainmostlysaturatedfat.Regularintakeofwater*Protein-richfoodsinclude:legumes(suchasbeans),nutsandseeds,soyproducts(includingfortifiedsoybeverage),eggs,fishandotherseafood,poultry,leanredmeats(includinggamemeatssuchasmoose,deerandcaribou),lowerfatmilkandyogurt,cheeseslowerinsodiumandfat.Nutritiousfoodsthatcontainfatsuchashomogenized(3.25%M.F.)milkshouldnotberestrictedforyoungchildren.WhatthismeansforCanadiansThemajorityofCanadiansdon’teatenoughvegetables,fruitsandwholegrainsandmanydrinkbeverageshighinsugars.ThismeansthatmostCanadianswillneedtomakedifferentchoicestomeettheserecommendations.Whatisneededisashifttowardsahighproportionofplant-basedfoods,withoutnecessarilyexcludinganimalfoodsaltogether.Animalfoodssuchaseggs,fishandotherseafood,poultry,leanredmeatssuchgamemeats,lowerfatmilkandyogurt,aswellascheeseslowerinsodiumandfatarenutritious‘everyday’foods.Someoftheseprotein-richfoodscanbehighinsodium(e.g.,saltednuts),sugars(e.g.,sweetenedyogurt)orsaturatedfat(e.g.,somemeatsandmanycheeses)andshouldbelimited.Theycanbeidentifiedusingthe%DailyValue(DV)ontheNutritionFactstable:5%orlessofthe%DVis“alittle”and15%ormoreofthe%DVis‘alot’ofsodium,sugarsorsaturatedfat.Ashifttowardsmoreplant-basedfoodscanhelpCanadians:.eatmorefibre-richfoods;.eatlessredmeat(beef,pork,lambandgoat);and.replacefoodsthatcontainmostlysaturatedfat(e.g.,cream,highfatcheesesandbutter)withfoodsthatcontainmostlyunsaturatedfat(e.g.,nuts,seeds,andavocado).Tohelpmeettheserecommendations,Canadianscanchoosenutritiousfoodsandbeverages,including:.foodsandbeveragesthatrequirelittleornopreparationsuchasfresh,frozenandcannedvegetablesandfruit,cannedlegumesorfish,tofu,plainmilkorfortifiedplant-basedbeverages;.foodsandbeveragesthatarepre-packagedforconvenience(suchaspre-washedsaladgreens,pre-cutfruit)ortoincreaseshelf-life(suchaspowderedmilk);

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.foodslikenuts,seeds,fattyfish,avocado,andvegetableoilsinsteadoffoodslikehighfatcheesesandcream;and.foodsobtainedthroughgardening,hunting,trapping,fishingandharvesting.Plainwateristhebeverageofchoicetohelpreducesugarsintakeandreducethefrequencyatwhichteethareexposedtosugars.DoyouagreewiththefollowingstatementsaboutthisGuidingPrinciple? Yes No Don’tknowItisrelevanttomyworkand/ormyorganization’swork. XItisclear. XItprovidesenoughinformation. X

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Recommendation1:Regularintakeofvegetables,fruit,wholegrains,andprotein-richfoods*–especiallyplant-basedsourcesofprotein*Protein-richfoodsinclude:legumes(suchasbeans),nutsandseeds,soyproducts(includingfortifiedsoybeverage),eggs,fishandotherseafood,poultry,leanredmeats(includinggamemeatssuchasmoose,deerandcaribou),lowerfatmilkandyogurt,cheeseslowerinsodiumandfat.Nutritiousfoodsthatcontainfatsuchashomogenized(3.25%M.F.)milkshouldnotberestrictedforyoungchildren.Doyouagreeordisagreewiththisrecommendation?.Stronglyagree.Somewhatagree.Somewhatdisagree.Stronglydisagree.Don’tknowWhatdoyoulikeaboutthisrecommendation?Therecommendationrecognizesthecontributionofproteinrichfoodssuchaspoultry,leanredmeats(includinggamemeatssuchasmoose,deerandcaribou)toabalanceddiet.Whatdoyoudislikeaboutthisrecommendation?Therecommendationistoo“simple”:Itdoesnotprovidesufficientinformation(e.g.inregardtohowfoodsareprepared/consumed-breaded/fried/sauced/skinonwhitemeatordarkmeatpoultryvsbroiled/grilled/roastedredmeatsorskinoffchicken).Similarconsiderationshouldalsoapplyinregardtohowtheotherfoodslistedareprepared(e.g.fruitandvegetablesinsauces).Ascurrentlywrittenitappearsthatpoultryregardlessofhowpreparedshouldbethechoice.Ataminimum,thewordingshouldbemodifiedasfollows“…leanpoultry,leanredmeats…”.Therecommendationdoesnotprovideinformationinregardtoactualproteinvalues,portionsizesandcalories(e.g.onewouldneedtoconsumealmost270morecaloriesfromchickpeastogetthesameamountofprotein-22grams-providedina75gramportionofporkwhichprovides138calories).Manyofthefoodslistedas“protein-rich”,particularlynuts,seedsandlegumes,donotmeetthecriteriaforproteinclaims(e.g.,excellent,high,source,contains).Therefore,theseshouldnotbereferredtoas“protein-rich”oreven“proteinfoods”.Thereisalackofconsistencyinthedefinitionofprotein-richfoodsbetweentheFoodGuideandMarketingtoChildrendiscussiondocuments.Consumersshopforfood;notnutrients.Mixingnutrientbasedrecommendations(e.g.proteingroupwithfoodspecifice.g.vegetablesandfruit)isconfusing.Creatingaproteingroupdoesadisservicetomilkandmilkproductsandmeatandalternatives.ConceivablyCanadianscouldfallshortonkeynutrientsfounddistinctlyinthesefoodgroups,forexample,calciumandironrespectively.Therecommendationdoesnotaddressnutrientdensity,portionsizes,calories,proteinvaluesorpreparationmethodswhichplayanimportantroleinabalanceddiet.Nutritionalguidanceshouldfocusonanindividual’stotaldietandlifestyle(e.g.focusonmoderation,variety,caloriebalanceandactivity/exerciseratherthanfocusingonindividualnutrientsorfoodstolimit).Therecommendationdoesnotrecognizetheimportanceofothernutrientsprovidedbynutrientdensefoodsandtheircontributiontoabalanceddiet.

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Meatandpoultryareanimportantcomponentofahealthyhumandiet.Theyprovideessentialaminoacids,mineralssuchasiron,vitamins,andotherdietaryrequirements.Animalproteinsaretheonlysinglesourcesofalltheessentialaminoacids.Animalproteinsareverydifficulttoreplaceonamacronutrientqualitybasis.Inadditiontohighqualityprotein,meatandpoultryalsoareimportantandrichsourcesofmicronutrientssuchasiron,zinc,selenium,andVitaminsB12,B6,thiamin,riboflavin,niacin,andpotassium.Meatandpoultryproductsinthemarketplacetoday,includingprocessedandenhancedmeatproducts,areavailableinanabundantvarietyofformulations,whichallowconsumerstoselectproductsbestsuitedfortheirnutritionalandlifestyleneeds,preferencesandcircumstances.HasHealthCanadaconductedmenumodellingtoconfirmthatifaconsumerfollowstheproposedguidingprinciplesandrecommendationsthatitwillbepossibletomeetanindividual’snutrientrequirements?In2015,itwasdeterminedthatalmosthalf(46%)ofCanadianstookatleastonesupplementaday.IsitanticipatedbasedontheproposedGuidingPrinciplesandRecommendationsthatincreaseduseofsupplementswillbeneededtoattainabalanceddiet? ConsumersshouldbeeducatedinthenutrientcontentofwholemusclemeatsandpoultryanddirectedtotheNFtofpreparedmeatsandotherpreparedfoodssuchthattheyareabletomakeknowledgeabledecisions(i.e.basedonfullnutritioninformationasprovidedintheNFtorelsewheree.g.online)thatwillmeettheirindividualneeds,preferencesandcircumstancesandresultinabalanceddiet(e.g.selectingnutrientdensefoodsandbeveragesovernon-nutrientdensefoodsandbeverages).Wequestiononwhatscientificbasis/evidenceHChasmovedfromthefollowingstatementonpage4ofthe2015HCEvidenceReviewforDietaryGuidancethat:“Furtherprecisionmaybeneededintheguidanceoncertaintopics.Morespecifically:•thelinkbetweenhigherintakesofredandprocessedmeatandincreasedriskofcolorectalcancer”towhatisnowpostedinHealthCanada’sSummaryofEvidenceBaseforGuidingPrinciplesandRecommendationsasrationalethat:“Redmeat(beef,pork,lambandgoat):Associationbetweenincreasedintakesofredmeat(beef,pork,lambandgoat)andincreasedriskofcolorectalcancer[8]Source:WorldCancerResearchFund2011:CUPreport:colorectalcancer”“Processedmeat:Associationbetweenincreasedintakesofprocessedmeat(meatsprocessedbysmoking,curingorsalting,oradditionofchemicalpreservatives)andincreasedriskofcolorectalcancer[15]Source:WorldCancerResearchFund2011:CUPreport:colorectalcancer”i.e.onwhatbasisis2011“evidence”thatwasquestionedin2015nowstatedasrationalein2017?Specifically,inregardtotheWCRF2011Report:WCRF’s2011CUPmeta-analysisindicatedprocessedmeatconsumedat50g/dhadan18percentincreasedriskforcolorectalcancer;100g/dofredmeatshoweda17percentincreasedriskforcolorectalcancer.However,Canadiansonaveragewereconsuming22gramsprocessedredmeatand74gramsoffreshredmeataday-levelsbelowthosefoundbyWCRFtobeproblematic,evenifprocessedpoultryisfactoredin.Furthermore,between2004and2015-theyearswhentheCCHSsurveywasconducted-redmeatconsumptiondeclinedbyhalfakilogram,accordingtoStatisticsCanada.BlanketstatementssuggestingpeoplereducetheirredmeatconsumptiondoagreatdisservicetoCanadiansbycontributingtoconfusionabouthealthyeatinganddistractingfromrealpublichealthconcernslikeobesityanddiabetes.Females,alreadylowconsumersofmeatandalternatives,wouldmostbenefitfromanadditionalservingofredmeatintheirdiet.FocusshouldbesquarelyplacedonreducingthealarmingstatisticthatCanadiansaregetting22%oftheirtotalcaloriesadayfromfoodslowinnutritionalvaluethatarenotpartofthefourmajorfoodgroupsinthecurrentFoodGuide.See:http://www.wcrf.org/sites/default/files/Colorectal-Cancer-2011-Report.pdfandhttp://www.statcan.gc.ca/pub/82-003-x/2006004/article/habit/4148989-eng.htm

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Recommendation2:InclusionoffoodsthatcontainmostlyunsaturatedfatinsteadoffoodsthatcontainmostlysaturatedfatDoyouagreeordisagreewiththisrecommendation?.Stronglyagree.Somewhatagree.Somewhatdisagree.Stronglydisagree.Don’tknowWhatdoyoulikeaboutthisrecommendation?N/AWhatdoyoudislikeaboutthisrecommendation?ConsumersshouldbeeducatedanddirectedtotheNFtsuchthattheyareabletomakeknowledgeabledecisions(i.e.basedonfullnutritioninformationasprovidedintheNFt)thatwillmeettheirindividualneeds,preferencesandcircumstancesandresultinabalanceddiet(e.g.selectingnutrientdensefoodsandbeveragesovernon-nutrientdensefoodsandbeverages).TheincidenceofType2diabetesandcardiovasculardiseaseareactuallyimplicatedwithsugarandrefinedcarbohydratesandnotnaturalsaturatedfat.WhentheCanadianHeartandStrokeFoundationreleasedtheirpositionpaper“SaturatedFat,HeartDiseaseandStroke“in2015,theFoundationstated“IfCanadianseatahealthy,balanceddietandappropriateportions,saturatedfatintakeshouldnotbeanissue.”(Source:https://www.heartandstroke.ca/-/media/pdf-files/canada/position-statement/saturatedfat-eng-final.ashx)Atotaldietapproach,includingallfoods,whileemphasizingtheimportanceofavariedandbalanceddietwithincalorieneedsandengaginginmoderateexercisearekeytoahealthylifestyle.

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Recommendation3:RegularintakeofwaterDoyouagreeordisagreewiththisrecommendation?.Stronglyagree.Somewhatagree.Somewhatdisagree.Stronglydisagree.Don’tknowWhatdoyoulikeaboutthisrecommendation?Basedoncurrentscience.Whatdoyoudislikeaboutthisrecommendation?N/A

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WewouldnowliketoaskyouforyourfeedbackontheGuidingPrincipleanditsrecommendationsoverall.Hereitisagainforreference.GuidingPrinciple1:Avarietyofnutritiousfoodsandbeveragesarethefoundationforhealthyeating.HealthCanadarecommends:.Regularintakeofvegetables,fruit,wholegrainsandprotein-richfoods*-especiallyplant-basedsourcesofprotein.Inclusionoffoodsthatcontainmostlyunsaturatedfat,insteadoffoodsthatcontainmostlysaturatedfat.Regularintakeofwater*Protein-richfoodsinclude:legumes(suchasbeans),nutsandseeds,soyproducts(includingfortifiedsoybeverage),eggs,fishandotherseafood,poultry,leanredmeats(includinggamemeatssuchasmoose,deerandcaribou),lowerfatmilkandyogurt,cheeseslowerinsodiumandfat.Nutritiousfoodsthatcontainfatsuchashomogenized(3.25%M.F.)milkshouldnotberestrictedforyoungchildren.IsthereanythingelseyouwouldliketosayaboutGuidingPrinciple1anditsrecommendations?Thestatementsmadearetoogeneralanddonottakethecurrentdietsofindividualsintoconsideration(i.e.thosealreadymakingchoicesthatresultinabalanceddiets;thosealreadyconsumingappropriateamountsoffruit/vegetable/meat/dairy/etc.).Thestatement“Whatisneededisashifttowardsahighproportionofplant-basedfoods,withoutnecessarilyexcludinganimalfoodsaltogether”couldbemoreappropriatelyworded“Whatisneededforsomeindividualsisashifttowardsahigherproportionofplant-basedfoodswhileconsuminganimalfoodsinmoderation.”Thestatement“Ashifttowardsmoreplant-basedfoodscanhelpCanadians:…eatlessredmeat(beef,pork,lambandgoat);and…”maynotbeappropriateforthosealreadyconsuminganappropriatemixoffoodsthatresultinabalanceddiet.Directingallconsumerstoconsumelessofcertainfoodsmayresultinconsumersnotattainingabalanceddiet.ThePrincipleandRecommendationsaretoo“simple”.Theydonotprovidesufficientinformation(e.g.inregardtohowfoodsareprepared/consumed-breaded/fried/sauced/skinonwhitemeatordarkmeatpoultryvsbroiled/grilled/roastedredmeatsorskinoffchicken).Similarconsiderationshouldalsoapplyinregardtohowtheotherfoodslistedareprepared.Ascurrentlywrittenitappearsthatpoultryregardlessofhowpreparedshouldbethechoice.Ataminimum,thewordingshouldbemodifiedasfollows“…leanpoultry,leanredmeats…”.Proteinvalues,portionsizesandcaloriesarenotincludedinthePrincipleorRecommendations(e.g.onewouldneedtoconsumealmost270morecaloriesfromchickpeastogetthesameamountofprotein-22grams-providedina75gramportionofporkwhichprovides138calories).TheRecommendationsdonotrecognizetheimportanceofothernutrientsprovidedbynutrientdensefoodsandtheircontributiontoabalanceddiet.ConsumersshouldbeeducatedinthenutrientcontentofwholemusclemeatsandpoultryanddirectedtotheNFtofpreparedmeatsandotherpreparedfoodssuchthattheyareabletomakeknowledgeabledecisions(i.e.basedonfullnutritioninformationasprovidedintheNFtorelsewheree.g.online)thatwillmeettheirindividualneeds,preferencesandcircumstancesandresultinabalanceddiet(e.g.selectingnutrientdensefoodsandbeveragesovernon-nutrientdensefoodsandbeverages).ThecurrentandamendedNFtprovidefactualinformationonwhichtomakeindividualchoicesthatwillresultinabalanceddietthatmeetsindividualneeds,preferencesandcircumstances.

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Consumereducation(e.g.startingattheelementaryschoollevel)isneededtoassistallconsumersinmakingknowledge-baseddecisionsthatwillmeettheirindividualneeds,preferenceandcircumstancesandresultinanoverallbalanceddiet.ConsumersshouldbeeducatedanddirectedtotheNFtsuchthattheyareabletomakeknowledgeabledecisions(i.e.basedonfullnutritioninformationasprovidedintheNFt)thatwillmeettheirindividualneeds,preferencesandcircumstancesandresultinabalanceddiet(e.g.selectingnutrientdensefoodsandbeveragesovernon-nutrientdensefoodsandbeverages).TherecommendationsaretoosimpleanddonotprovideactionableguidancetoenableCanadianstomakeinformeddecisionsabouthowtoeatahealthy,nutrientadequate,balanceddiet.Nutritionalguidanceshouldencourageconsumingnutrientdensefoods,whichincludesmeatandpoultry,andmoveawayfromconsumingenergydensefoods.Providingpractical,affordable,andachievableguidancebydemonstratinghowtochoosehealthieralternativesorincorporateallfoodsinabalanceddietisneeded.Canadiansarenotprovidedwithfulsomeadviceonchoosingabalanced,eatingpatternbyfocusingonthreenutrients.Canadiansareseekingmore,notless,nutritioninformationgaugingtheirinterestinvitamins,minerals,antioxidants,phytochemicals,etc.Wequestiononwhatscientificbasis/evidenceHChasmovedfromthefollowingstatementonpage4ofthe2015HCEvidenceReviewforDietaryGuidancethat:“Furtherprecisionmaybeneededintheguidanceoncertaintopics.Morespecifically:•thelinkbetweenhigherintakesofredandprocessedmeatandincreasedriskofcolorectalcancer”towhatisnowpostedinHealthCanada’sSummaryofEvidenceBaseforGuidingPrinciplesandRecommendationsasrationalethat:“Redmeat(beef,pork,lambandgoat):Associationbetweenincreasedintakesofredmeat(beef,pork,lambandgoat)andincreasedriskofcolorectalcancer[8]Source:WorldCancerResearchFund2011:CUPreport:colorectalcancer”“Processedmeat:Associationbetweenincreasedintakesofprocessedmeat(meatsprocessedbysmoking,curingorsalting,oradditionofchemicalpreservatives)andincreasedriskofcolorectalcancer[15]Source:WorldCancerResearchFund2011:CUPreport:colorectalcancer”i.e.onwhatbasisis2011“evidence”thatwasquestionedin2015nowstatedasrationalein2017?Specifically,inregardtotheWCRF2011Report:WCRF’s2011CUPmeta-analysisindicatedprocessedmeatconsumedat50g/dhadan18percentincreasedriskforcolorectalcancer;100g/dofredmeatshoweda17percentincreasedriskforcolorectalcancer.However,Canadiansonaveragewereconsuming22gramsprocessedredmeatand74gramsoffreshredmeataday-levelsbelowthosefoundbyWCRFtobeproblematic,evenifprocessedpoultryisfactoredin.Furthermore,between2004and2015-theyearswhentheCCHSsurveywasconducted-redmeatconsumptiondeclinedbyhalfakilogram,accordingtoStatisticsCanada.BlanketstatementssuggestingpeoplereducetheirredmeatconsumptiondoadisservicetoCanadiansbycontributingtoconfusionabouthealthyeatinganddistractingfromrealpublichealthconcernslikeobesityanddiabetes.Females,alreadylowconsumersofmeatandalternatives,wouldmostbenefitfromanadditionalservingofredmeatintheirdiet.FocusshouldbesquarelyplacedonreducingthealarmingstatisticthatCanadiansaregetting22%oftheirtotalcaloriesadayfromfoodslowinnutritionalvaluethatarenotpartofthefourmajorfoodgroupsinthecurrentFoodGuide.See:http://www.wcrf.org/sites/default/files/Colorectal-Cancer-2011-Report.pdfandhttp://www.statcan.gc.ca/pub/82-003-x/2006004/article/habit/4148989-eng.htm.

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Basedonyourexperienceworkingwitholderadults,childrenandyouth,Indigenouspopulations,low-incomepeople,newcomers,orpeoplewithlowliteracy,isthereanyfurtherfeedbackthatyouwouldliketogiveus?Thestatementsmadearetoogeneralanddonottakethecurrentdietsofindividualsintoconsideration(i.e.thosealreadymakingchoicesthatresultinabalanceddiets;thosealreadyconsumingappropriateamountsoffruit/vegetable/meat/dairy/etc.).Thestatement“Whatisneededisashifttowardsahighproportionofplant-basedfoods,withoutnecessarilyexcludinganimalfoodsaltogether”couldbemoreappropriatelyworded“Whatisneededforsomeindividualsisashifttowardsahigherproportionofplant-basedfoodswhileconsuminganimalfoodsinmoderation.”Thestatement“Ashifttowardsmoreplant-basedfoodscanhelpCanadians:…eatlessredmeat(beef,pork,lambandgoat);and…”maynotbeappropriateforthosealreadyconsuminganappropriatemixoffoodsthatresultinabalanceddiet.Directingallconsumerstoconsumelessofcertainfoodsmayresultinconsumersnotattainingabalanceddiet.The1992FoodGuidesuggested100to300gramsofcookedmeatadaydependingonyourageandgender.Accordingtothe2004CCHSdata,only1in4adultmaleshadmorethan300gramsofmeatandalternativesaday.Nofemaleagegroupaveragedmorethan200gramsofmeatandalternativesaday.Aswell,14%to18%ofgirlsaged9to18hadlessthan100grams,asdid15%ofwomenaged71orolder.(Source:www.statcan.gc.ca/pub/82-003-x/2006004/article/habit/4148989-eng.htm).Advicetoreducemeatconsumptionmayhaveanegativeimpactonthebalanceddietsofsomeconsumers(e.gfemalesasthesemessagesseemtoresonatemostwithfemales).WhatisthebasisforsayingCanadiansshouldconsumelessredmeatwhenthedatashowstheyhavealreadyadjustedconsumptiondowntoanappropriateleveland,meanwhile,infants,younggirlsandseniorswouldseehealthimprovementiftheyconsumedmoreleanmeat?AccordingtoStatsCanada’sapparentdisappearancedata,meatconsumptionhasfallensince2004.GovernmentadvicetofurtherreducemeatconsumptionmayhaveunintendedconsequencesparticularlywhenitcomestointakesofvitaminB12,andironandzincwhicharemorebioavailableinanimalproductsandenhancestheabsorptionfromplantsources.ThecurrentandamendedNFtprovidefactualinformationonwhichtomakeindividualchoicesthatwillresultinabalanceddietthatmeetsindividualneeds,preferencesandcircumstances.Consumereducation(e.g.startingattheelementaryschoollevel)isneededtoassistallconsumersinmakingknowledge-baseddecisionsthatwillmeettheirindividualneeds,preferenceandcircumstancesandresultinanoverallbalanceddiet.ConsumersshouldbeeducatedanddirectedtotheNFtsuchthattheyareabletomakeknowledgeabledecisions(i.e.basedonfullnutritioninformationasprovidedintheNFt)thatwillmeettheirindividualneeds,preferencesandcircumstancesandresultinabalanceddiet(e.g.selectingnutrientdensefoodsandbeveragesovernon-nutrientdensefoodsandbeverages).ThePrincipleandRecommendationsaretoo“simple”.Theydonotprovidesufficientinformation(e.g.inregardtohowfoodsareprepared/consumed-breaded/fried/sauced/skinonwhitemeatordarkmeatpoultryvsbroiled/grilled/roastedredmeatsorskinoffchicken).Ascurrentlywrittenitappearsthatpoultryregardlessofhowpreparedshouldbethechoice.Ataminimum,thewordingshouldbemodifiedasfollows“…leanpoultry,leanredmeats…”.Proteinvalues,portionsizesandcaloriesarenotincludedinthePrincipleorRecommendations(e.g.onewouldneedtoconsumealmost270morecaloriesfromchickpeastogetthesameamountofprotein-22grams-providedina75gramportionofporkwhichprovides138calories).TheRecommendationsdonotrecognizetheimportanceofothernutrientsprovidedbynutrientdensefoodsandtheircontributiontoabalanceddiet.

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ConsumersshouldbeeducatedinthenutrientcontentofwholemusclemeatsandpoultryanddirectedtotheNFtofpreparedmeatsandotherpreparedfoodssuchthattheyareabletomakeknowledgeabledecisions(i.e.basedonfullnutritioninformationasprovidedintheNFtorelsewheree.g.online)thatwillmeettheirindividualneeds,preferencesandcircumstancesandresultinabalanceddiet(e.g.selectingnutrientdensefoodsandbeveragesovernon-nutrientdensefoodsandbeverages).Wequestiononwhatscientificbasis/evidenceHChasmovedfromthefollowingstatementonpage4ofthe2015HCEvidenceReviewforDietaryGuidancethat:“Furtherprecisionmaybeneededintheguidanceoncertaintopics.Morespecifically:•thelinkbetweenhigherintakesofredandprocessedmeatandincreasedriskofcolorectalcancer”towhatisnowpostedinHealthCanada’sSummaryofEvidenceBaseforGuidingPrinciplesandRecommendationsasrationalethat:“Redmeat(beef,pork,lambandgoat):Associationbetweenincreasedintakesofredmeat(beef,pork,lambandgoat)andincreasedriskofcolorectalcancer[8]Source:WorldCancerResearchFund2011:CUPreport:colorectalcancer”“Processedmeat:Associationbetweenincreasedintakesofprocessedmeat(meatsprocessedbysmoking,curingorsalting,oradditionofchemicalpreservatives)andincreasedriskofcolorectalcancer[15]Source:WorldCancerResearchFund2011:CUPreport:colorectalcancer”i.e.onwhatbasisis2011“evidence”thatwasquestionedin2015nowstatedasrationalein2017?Specifically,inregardtotheWCRF2011Report:WCRF’s2011CUPmeta-analysisindicatedprocessedmeatconsumedat50g/dhadan18percentincreasedriskforcolorectalcancer;100g/dofredmeatshoweda17percentincreasedriskforcolorectalcancer.However,Canadiansonaveragewereconsuming22gramsprocessedredmeatand74gramsoffreshredmeataday-levelsbelowthosefoundbyWCRFtobeproblematic,evenifprocessedpoultryisfactoredin.Furthermore,between2004and2015-theyearswhentheCCHSsurveywasconducted-redmeatconsumptiondeclinedbyhalfakilogram,accordingtoStatisticsCanada.BlanketstatementssuggestingpeoplereducetheirredmeatconsumptiondoagreatdisservicetoCanadiansbycontributingtoconfusionabouthealthyeatinganddistractingfromrealpublichealthconcernslikeobesityanddiabetes.Females,alreadylowconsumersofmeatandalternatives,wouldmostbenefitfromanadditionalservingofredmeatintheirdiet.FocusshouldbesquarelyplacedonreducingthealarmingstatisticthatCanadiansaregetting22%oftheirtotalcaloriesadayfromfoodslowinnutritionalvaluethatarenotpartofthefourmajorfoodgroupsinthecurrentFoodGuide.Thesourcesofthestatscitedare:http://www.wcrf.org/sites/default/files/Colorectal-Cancer-2011-Report.pdfandhttp://www.statcan.gc.ca/pub/82-003-x/2006004/article/habit/4148989-eng.htm.Therecommendationsshouldrecognizespecificnutrientrequirementsforcertainsubpopulations,specificallyproteinneedsthroughoutthelifespan.Althoughmeatandpoultryproductssupplyessentialnutritionacrosstheboard,theirhighironcontentiscriticallyimportanttocertainsubpopulations,suchaschildrenwithanemiaorpregnantwomen.Thereductionofironinthedietcouldleadtodeficienciesthathavelong-termhealtheffectsifnotaddressed.Supplementationmaybeanoption,butthehemeironinmeatisthemostabsorbableformofironknown.Throughouttheirlifespan,varioussubpopulations,inthiscasechildrenandpregnantwomen,haveincreasedproteinneedsduringgrowthanddevelopment,andmeatandpoultryasnutrientdensefoodsarealogicalsource.Perserving,meat,poultry,andfishprovidemoreproteinthandairy,eggs,legumes,orcereals,vegetables,ornuts.Proteiniscriticalfordeveloping,maintaining,andrepairingstrongmusclesanditisvitalforreducingthemusclelossthatoftenoccurswithaging.Finally,researchshows

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thatmeat’shighproteinandlowcarbohydratecontenttranslatesintoalowglycemicindexinpeoplewhoconsumeit,whichoffersbenefitsforbothweightanddiabetescontrol.1,2

Note:Ifyoudonotworkwithanyofthesegroupsyouarestillwelcometorespondtothisquestionasyouseefit.

1Leidy,Mattes.Higherproteinintakepreservesleanmassandsatietywithweightlossinpre-obeseandobesewomen.Obesity.ObesRes.2007;15:421-429.2DonaldK.Layman,EllenM.Evans,DonnaErickson,JenniferSeyler,JudyWeber,DeborahBagshaw,AmyGriel,TriciaPsota,andPennyKris-Etherton.AModerate-ProteinDietProducesSustainedWeightLossandLong-TermChangesinBodyCompositionandBloodLipidsinObeseAdults.TheJournalofNutrition,March2009.

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GuidingPrinciple2Processedorpreparedfoodsandbeverageshighinsodium,sugars,orsaturatedfatunderminehealthyeating.Basedontheavailableevidence,HealthCanadaisproposingthefollowingGuidingprincipleandRecommendationstoemphasizethatprocessedorpreparedfoodsandbeverageshighinsodium,sugarsorsaturatedfatshavethepotentialtoimpacthealth,whenconsumedonaregularbasis.HealthCanadarecognizesthattheselesshealthychoiceswillbeconsumedattimes.Whatmattersmostiswhatpeopleeatonaregularbasis.HealthCanadaacknowledgesthatsomeformsofprocessing,suchaspasteurization,havepublichealthbenefits.However,foodsprocessedorpreparedwithhighamountsofsodium,sugars,orsaturatedfatcanhaveanegativeimpactonhealth.GuidingPrinciple2:Processedorpreparedfoodsandbeverageshighinsodium,sugarsorsaturatedfatunderminehealthyeating.HealthCanadarecommends:.Limitedintakeofprocessedorpreparedfoodshighinsodium,sugarsorsaturatedfat.Avoidanceofprocessedorpreparedbeverageshighinsugars****Processedorpreparedbeveragesthatcanbehighinsugarsinclude:softdrinks,fruit-flavoureddrinks,100%fruitjuice,flavouredwaterswithaddedsugars,energydrinks,sportdrinks,andothersweetenedhotorcoldbeverages,suchasflavouredmilksandflavouredplant-basedbeverages.WhatthismeansforCanadiansTheconsumptionofprocessedorpreparedfoodsisontheriseinCanada.AtleasthalfofthesugarsintakeofCanadianscomefromprocessedorpreparedfoodsandbeverages,suchsoftdrinks,sweetbakedgoods,fruitjuice,confectionary,breakfastcereals,andsweeteneddairyproducts.MorethanthreequartersofthesodiumCanadiansconsumecomesfromprocessedfoodsorfoodspreparedatrestaurants.Aswell,thesaturatedfatintakeofabouthalfofCanadiansistoohigh.SoftdrinksandfruitdrinksaremainsourcesofsugarsinthedietsofCanadians.AvoidingthesebeveragesandotherbeverageshighinsugarscanhelpCanadianscutdownonsugarsintake.Thisprotectsoralhealth,andmayreducetheriskofobesityandtype2diabetes.Foodsandbeverageshighinsodium,sugarsorsaturatedfatcanbeidentifiedusingthe%DailyValue(DV)ontheNutritionFactstable:15%ormoreofthe%DVis“alot”ofsodium,sugarsorsaturatedfat.DoyouagreewiththefollowingstatementsaboutthisGuidingPrinciple? Yes No Don’tknowItisrelevanttomyworkand/ormyorganization’swork. XItisclear. XItprovidesenoughinformation. X

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Recommendation1:Limitedintakeofprocessedorpreparedfoodshighinsodium,sugarsorsaturatedfatDoyouagreeordisagreewiththisrecommendation?.Stronglyagree.Somewhatagree.Somewhatdisagree.Stronglydisagree.Don’tknowWhatdoyoulikeaboutthisrecommendation?N/AWhatdoyoudislikeaboutthisrecommendation?Dietarydecisionsshouldbebasedonthefullnutritionalmakeupofafoodnotonwhetherafoodisprocessed/preparedandnotbasedononlythreenutrients.DuetoindividualcircumstancesprocessedorpreparedfoodsandbeveragesmaybemoreaccessibletocertainconsumersandsuchfoodswhensoldpackagedcarryaNFtonwhichtomakefoodchoicesthatmeetindividualneeds,preferencesandcircumstances.ConsumersshouldbeeducatedanddirectedtotheNFtorothersourcesofnutrientdatasuchthattheyareabletomakeknowledgeabledecisions(i.e.basedonfullnutritioninformationasprovidedintheNFtorviaonlinenutrientinformation/databanks)thatwillmeettheirindividualneeds,preferencesandcircumstancesandresultinabalanceddiet(e.g.selectingnutrientdensefoodsandbeveragesovernon-nutrientdensefoodsandbeverages).Nutritionalrecommendationsshouldencourageconsumingnutrientdensefoods,whichincludesmeatandpoultry,andmoveawayfromconsumingenergydensefoods.Recommendationsthatencouragereducedintakeofcertainfoodproducts,likethosethatareprocessed,couldhaveunintendedconsequenceontheintakeofvegetables,fiber,protein,grains,anddairy.Pastrecommendationstoeatalowfatdietledinparttoover-consumptionofotherfoodcomponents;consumersmerelyreplacedoneover-consumeddietarycomponentwithanother.Consumerswouldbebetterservedbyprovidingguidanceaboutportioncontrolandeducationinregardtoselectingand/orpreparingfoods.Eatingabalanceddietfromallfoodgroupsandengaginginmoderateexercisearekeytoahealthylifestyle.

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Recommendation2:Avoidanceofprocessedorpreparedbeverageshighinsugars****Processedorpreparedbeveragesthatcanbehighinsugarsinclude:softdrinks,fruit-flavoureddrinks,100%fruitjuice,flavouredwaterswithaddedsugars,energydrinks,sportdrinks,andothersweetenedhotorcoldbeverages,suchasflavouredmilksandflavouredplant-basedbeverages.Doyouagreeordisagreewiththisrecommendation?.Stronglyagree.Somewhatagree.Somewhatdisagree.Stronglydisagree.Don’tknowWhatdoyoulikeaboutthisrecommendation?N/AWhatdoyoudislikeaboutthisrecommendation?ThisrecommendationdoesnotdirectconsumerstotheNFtforfullnutritioninformationinregardtotheproductstheyareconsideringand/orforcomparisonpurposesbetweentheproductsbeingconsidered.ConsumersshouldbeeducatedanddirectedtotheNFtsuchthattheyareabletomakeknowledgeabledecisions(i.e.basedonfullnutritioninformationasprovidedintheNFt)thatwillmeettheirindividualneeds,preferencesandcircumstancesandresultinabalanceddiet(e.g.selectingnutrientdensefoodsandbeveragesovernon-nutrientdensefoodsandbeverages).Careshouldbetakeninusingbroadsweepingstatements.PortioncontrolandguidanceonhowtoattainabalanceddietwouldbemorehelpfultoCanadiansthanblanketstatementstoavoidalltogether.TherecommendationdoesnotdirecttheconsumertoconsulttheNutritionFactstablewherethebeverage’scompletenutritionalinformationisavailable.ThefulsomeinformationprovidedintheNutritionFactstablesallowsconsumerstomakecomparisonsonwhichtobaseindividualchoicesthatbestfittheirdietarypreferencesandlifestyleneeds.

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WewouldnowliketoaskyouforyourfeedbackonthisGuidingPrincipleanditsrecommendationsoverall.Hereitisagain:GuidingPrinciple2:Processedorpreparedfoodsandbeverageshighinsodium,sugarsorsaturatedfatunderminehealthyeating.HealthCanadarecommends:.Limitedintakeofprocessedorpreparedfoodshighinsodium,sugarsorsaturatedfat.Avoidanceofprocessedorpreparedbeverageshighinsugars****Processedorpreparedbeveragesthatcanbehighinsugarsinclude:softdrinks,fruit-flavoureddrinks,100%fruitjuice,flavouredwaterswithaddedsugars,energydrinks,sportdrinks,andothersweetenedhotorcoldbeverages,suchasflavouredmilksandflavouredplant-basedbeverages.IsthereanythingelseyouwouldliketosayaboutGuidingPrinciple#2andtherecommendations?Notallprocessedorpreparedfoodsarecreatedequal.Dietarydecisionsshouldbebasedonthefullnutritionalmakeupofafoodnotonwhetherafoodisprocessed/preparedandnotbasedononlythreenutrients.DuetoindividualcircumstancesprocessedorpreparedfoodsandbeveragesmaybemoreaccessibletocertainconsumersandsuchfoodswhensoldpackagedcarryaNFtonwhichtomakefoodchoicesthatmeetindividualneeds,preferencesandcircumstances.ConsumersshouldbeeducatedanddirectedtotheNFtsuchthattheyareabletomakeknowledgeabledecisions(i.e.basedonfullnutritioninformationasprovidedintheNFt)thatwillmeettheirindividualneeds,preferencesandcircumstancesandresultinabalanceddiet(e.g.selectingnutrientdensefoodsandbeveragesovernon-nutrientdensefoodsandbeverages).Consumerswouldbebetterservedbyprovidingguidanceaboutportioncontrolandeducationinregardtoselectingand/orpreparingfoods.Eatingabalanceddietfromallfoodgroupsandengaginginmoderateexercisearekeytoahealthylifestyle.Therecouldbeunintended,adverseconsequenceswhenconsumersareencouragedtoreplaceonedietarycomponentwithanother.SuchareplacementcouldleadtomoreenergydenseorlessnutrientdensechoicesastothealternativechoicemaymeetthecriteriaoutlinedinthisGuidingPrinciple.Choicesshouldbemadebasedonafoodorbeverage’scompletenutritioninformation.Recognizingtheeatingpatternsofaverageconsumersandprovidinginformationabouthowtheycaneatamorebalanceddietwithinthecontextoftheirexistingfoodchoicesiscritical.Thisincludesdemonstratingthatallfoodscanfitinabalanceddiet.Providingpractical,affordableandachievableguidancebydemonstratinghowtochooseandincorporateallfoodsandbeveragesinabalanceddietisneeded.Basedonyourexperienceworkingwitholderadults,childrenandyouth,Indigenouspopulations,low-incomepeople,newcomers,orpeoplewithlowliteracy,isthereanyfurtherfeedbackthatyouwouldliketogiveus?DuetoindividualcircumstancesprocessedorpreparedfoodsandbeveragesmaybemoreaccessibletocertainconsumersandsuchfoodswhensoldpackagedcarryaNFtonwhichtomakefoodchoicesthatmeetindividualneeds,preferencesandcircumstances.ThecurrentandamendedNFtprovidefactualinformationonwhichtomakeindividualchoicesthatwillresultinabalanceddietthatmeetsindividualneeds,preferencesandcircumstances.

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Consumereducation(e.g.startingattheelementaryschoollevel)isneededtoassistallconsumersinmakingknowledge-baseddecisionsthatwillmeettheirindividualneeds,preferenceandcircumstancesandresultinanoverallbalanceddiet.ConsumersshouldbeeducatedanddirectedtotheNFtsuchthattheyareabletomakeknowledgeabledecisions(i.e.basedonfullnutritioninformationasprovidedintheNFt)thatwillmeettheirindividualneeds,preferencesandcircumstancesandresultinabalanceddiet(e.g.selectingnutrientdensefoodsandbeveragesovernon-nutrientdensefoodsandbeverages).Nutritionalneedsvaryoverthelifespan.Itisessentialthatrecommendationsforspecificsub-populationsarecommunicatedclearlyanddonotmisinformtheintendedaudience.Thepotentialforunintended,adverseconsequencesistoogreatwhenprovidingoversimplifiednutritionalguidance.Note:Ifyoudonotworkwithanyofthesegroupsyouarestillwelcometorespondtothisquestionasyouseefit.

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GuidingPrinciple3Basedontheavailableevidence,HealthCanadaisproposingthefollowingGuidingprincipleandRecommendationstohighlightthatknowledgeandskillsareapracticalwaytosupporthealthyeating,andlimitrelianceonprocessedandpreparedfoodshighinsodium,sugarsorsaturatedfat.GuidingPrinciple3:Knowledgeandskillsareneededtonavigatethecomplexfoodenvironmentandsupporthealthyeating.HealthCanadarecommends:.Selectingnutritiousfoodswhenshoppingoreatingout.Sharingmealswithfamilyandfriendswheneverpossible.PlanningandpreparinghealthymealsandsnacksWhatthismeansforCanadiansFewerCanadiansarepreparingmealsfromscratch,whichinvolvestransformingbasicingredientsintocomplete,culturallyappropriatemeals.Canadiansarealsoincreasinglyreliantonconveniencefoods.Theincreaseduseofconveniencefoodsisnotalwaysduetolimitedskills,butalsototimeconstraints,orsocialandeconomicconsiderations.Planningandpreparinghealthymealsandsnacksathome,andselectingnutritiousfoodsatthegrocerystoreorwheneatingout,areallskillsthatcanhelpsupporthealthyeating.Preparingandsharingfoodbringsenjoymenttoeatingwhendoneinthecompanyoffamilyandfriends.Havingmealstogethercanhelpreinforcepositiveeatinghabitsandhelpchildrendevelophealthyattitudestowardsfood.Itcanalsobeawayforpeopletotakepartinfoodculturestheydidnotgrowupwith.Asskillsarelearnedandused,theprocesstoselect,planandpreparemealscanbecomelesstime-consumingandmoreroutine.Buildingafoundationofknowledgeandskillscancontributetoimprovedfoodchoicesatanyageandcanhelpsupportlife-longhealthyeatinghabits.Understandingwherefoodcomesfromandhowitispreparedcansupportmoremindfuleatingpractices.Thesepracticesincludethingssuchastakingtimetoeatandsavoureverybite,payingattentiontofeelingsofhungerandfullness,eatingslowlywithenjoyment,andavoidingdistractionswhileeating.DoyouagreewiththefollowingstatementsaboutthisGuidingPrinciple? Yes No Don’tknowItisrelevanttomyworkand/ormyorganization’swork. XItisclear XItprovidesenoughinformation. X

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Recommendation1:SelectingnutritiousfoodswhenshoppingoreatingoutDoyouagreeordisagreewiththisrecommendation?.Stronglyagree.Somewhatagree.Somewhatdisagree.Stronglydisagree.Don’tknowWhatdoyoulikeaboutthisrecommendation?Encouragesconsumerstomake“nutritiouschoices”.Whatdoyoudislikeaboutthisrecommendation?Therecommendationdoesn’tassistconsumersinmaking“nutritiouschoices”(e.g.doesn’treferenceneedforeducationordirectconsumerstotheNFtonwhichfact-basedchoicescanbemadeandfoodscanbecompared).Thefoodenvironmentisnomorecomplexthanotherenvironmentsconsumersmustnavigatedaily.TherecommendationdoesnotprovideinformationonhowCanadianscanchoosemorenutritiousproducts.ProvidingguidanceorinstructionstoconsulttheNutritionFactstablewouldallowconsumerstocomparedifferentproductsandenableconsumerstochooseproductsthatbestfittheirnutritionalandlifestyleneeds,preferencesandcircumstances.

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Recommendation2:PlanningandpreparinghealthymealsandsnacksDoyouagreeordisagreewiththisrecommendation?.Stronglyagree.Somewhatagree.Somewhatdisagree.Stronglydisagree.Don’tknowWhatdoyoulikeaboutthisrecommendation?Encouragesconsumerstoplanandpreparemealsandsnacks.Whatdoyoudislikeaboutthisrecommendation?Therecommendationistoosimplistic.Itencouragesconsumerstoplanandprepare“healthy”mealsandsnacksbutdoesn’ttellthemhowtodothis(e.g.doesn’treferenceeducationordirectconsumerstotheNFt).Consumerswouldbebetterservedifprovidedwithguidanceabouthowtoselectand/orpreparemealsincludingtheuseoftheinformationprovidedintheNutritionFactstableformulti-ingredientfoodsandavailableinonlinedatabases,etcforsingleingredientfoods(includingmeat,poultry,fruits,vegetables,etc).Forsomeconsumers,mealpreparationisachallenge.Thesechallengesmayariseduetolimitedexperiencepreparingmeals,aswellaslimitedtimetoshop/cook/affordthemealsconsumerswanttoservetheirfamilies.Guidanceshouldprovidestrategiesthathelpconsumersachieveabalanceddietwithintheirlifestyleconstraints.

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Recommendation3:SharingmealswithfamilyandfriendswheneverpossibleDoyouagreeordisagreewiththisrecommendation?.Stronglyagree.Somewhatagree.Somewhatdisagree.Stronglydisagree.Don’tknowWhatdoyoulikeaboutthisrecommendation?N/AWhatdoyoudislikeaboutthisrecommendation?Donotviewthisasanappropriaterecommendationforeatingwellasitisnotarealityforcertainindividualsandmayhavenegativeimpact(s)onsuchindividuals.Sharingmealswithfamilyandfriendsmaynotbearealityforcertainindividuals.Mealcompanionshipmayhavenoimpactonhealthyeating.Recommendationsthatdonotconsiderhowconsumersliveandeatwillnotbeadoptedandthereforewillnotimprovepublichealthoutcomes.

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WewouldnowliketoaskyouforyourfeedbackontheGuidingPrinciple3anditsrecommendationsoverall.Hereitisagain:GuidingPrinciple3:Knowledgeandskillsareneededtonavigatethecomplexfoodenvironmentandsupporthealthyeating.HealthCanadarecommends:.Selectingnutritiousfoodswhenshoppingoreatingout.Planningandpreparinghealthymealsandsnacks.SharingmealswithfamilyandfriendswheneverpossibleIsthereanythingelseyouwouldliketosayaboutGuidingPrinciple3anditsrecommendations?Thefoodenvironmentisnomore“complex”thananyotherenvironment/activitythatconsumersengageinandmakeindividualdecisions/choicesin.Educationandfactual,fulsomedataisneededratherthansimplifiedmessagesthatprovidegeneralitiesthatmaynotbeapplicabletoindividualconsumerneeds,preferencesandcircumstances.Theprincipleandrecommendationsdonottellconsumershowtodothesethings.Educationisneeded.Consumereducation(e.g.startingattheelementaryschoollevel)isneededtoassistallconsumersinmakingknowledge-baseddecisionsthatwillmeettheirindividualneeds,preferenceandcircumstancesandresultinanoverallbalanceddiet.ThecurrentandamendedNFtprovidefactualinformationonwhichtomakeindividualchoicesthatwillresultinabalanceddietthatmeetsindividualneeds,preferencesandcircumstances.ConsumersshouldbeeducatedanddirectedtotheNFtsuchthattheyareabletomakeknowledgeabledecisions(i.e.basedonfullnutritioninformationasprovidedintheNFt)thatwillmeettheirindividualneeds,preferencesandcircumstancesandresultinabalanceddiet(e.g.selectingnutrientdensefoodsandbeveragesovernon-nutrientdensefoodsandbeverages).Duetoindividualcircumstances“sharingmealswithfamilyandfriends”maynotberealityforcertainindividualsandmayhavenegativeimpact(s)onsuchindividuals.Nutritionalguidanceshouldcenteraroundatotaldietapproach,whichhighlightsmoderation,variety,andcaloriebalanceratherthanfocusingonnutrientsorfoodstolimit.Providingpractical,affordable,andachievableguidancebydemonstratinghowtoincorporateallfoodsinabalanceddietisneeded. Basedonyourexperienceworkingwitholderadults,childrenandyouth,Indigenouspopulations,low-incomepeople,newcomers,orpeoplewithlowliteracy,isthereanyfurtherfeedbackthatyouwouldliketogiveus?Thefoodenvironmentisnomore“complex”thananyotherenvironment/activitythatconsumersengageinandmakeindividualdecisions/choicesin.Educationandfactual,fulsomedataisneededratherthansimplifiedmessagesthatprovidegeneralitiesthatmaynotbeapplicabletoindividualconsumerneeds,preferencesandcircumstances.Theprincipleandrecommendationsdonottellconsumershowtodothesethings.Educationisneeded.Consumereducation(e.g.startingattheelementaryschoollevel)isneededtoassistallconsumersinmakingknowledge-baseddecisionsthatwillmeettheirindividualneeds,preferenceandcircumstancesandresultinanoverallbalanceddiet.ThecurrentandamendedNFtprovidefactualinformationonwhichtomakeindividualchoicesthatwillresultinabalanceddietthatmeetsindividualneeds,preferencesandcircumstances.

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ConsumersshouldbeeducatedanddirectedtotheNFtandotheronlinesourcesofnutritioninformation(e.g.nutrientdatabases)suchthattheyareabletomakeknowledgeabledecisions(i.e.basedonfullnutritioninformationasprovidedintheNFtorindatabases)thatwillmeettheirindividualneeds,preferencesandcircumstancesandresultinabalanceddiet(e.g.selectingnutrientdensefoodsandbeveragesovernon-nutrientdensefoodsandbeverages,portionsize,calories,etc).Duetoindividualcircumstances“sharingmealswithfamilyandfriends”maynotberealityforcertainindividualsandsuchstatementsmayhavenegativeimpact(s)onsuchindividuals.Note:Ifyoudonotworkwithanyofthesegroupsyouarestillwelcometorespondtothisquestionasyouseefit.

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ConsiderationsHealthyeatingrecommendationscanmakeanimportantcontributiontonutritionalhealth.Todoso,theymustberelevantintheCanadiancontext,nomatterwherepeoplelive,work,learnorplay.DeterminantsofhealthFoodchoicesarenotsimplyamatterofpersonalchoice.Therearemanyinterrelatedfactorsthatinfluenceourabilitytomakehealthyfoodchoices,includingaccesstoandavailabilityofnutritiousfoods,culture,andthesocialandphysicalenvironment1.HealthCanada’sproposedhealthyeatingrecommendationsarebasedonthebestavailableevidence,whileconsideringthathealthychoicescanbeaffordable,foundindifferentregionsofCanadaandenjoyedbydifferentcultures.Forexample,arangeofnutritiousfoodsformthefoundationofhealthyeating:frozen,packagedandcannedproductsareconvenientandnutritiousoptions,especiallywhenfreshfoodisoutofseason,morecostlyorunavailable.HealthCanada’sproposedhealthyeatingrecommendationsaimtoimprovehealthofthewholepopulation,whileconsideringtheneedsofsub-groupstoavoidincreasingunfairandavoidabledifferencesinhealthstatus2.CulturaldiversityCombiningnutritiousfoodsinwaysthatreflectculturalpreferencesandfoodtraditionscansupporthealthyeating.Theculturalmake-upinCanadaisrichanddiversewithover200differentethnicoriginsidentifiedontheCanadianCensus3.Partofthisdiversityisrepresentedinthetraditions,cultureandlifestylesofIndigenouspopulations.Traditionalfoodsandtheharvestingoftraditionalfoodsareintrinsicallylinkedtoidentityandculture,andcontributetooverallhealth4.EnvironmentThewayourfoodisproduced,processed,distributed,andconsumed–includingthelossesandwasteoffood–canhaveenvironmentalimplications,suchasgreenhousegasemissions(GHG),soildegradation,decreasesinwaterqualityandavailability,andwildlifeloss5.In2014,thevalueoffoodwasteandlossinCanadawasestimatedat$31billion6.TheprimaryfocusofHealthCanada’sproposedhealthyeatingrecommendationsistosupporthealth.However,therearealsopotentialenvironmentalbenefitsofshiftingtowardshealthyeating.Ingeneral,dietshigherinplant-basedfoodsandlowerinanimal-basedfoodsareassociatedwithalesserenvironmentalimpact,whencomparedtocurrentdietshighinsodium,sugarsandsaturatedfat7.Theapplicationofskills,suchasplanningmealsandfoodpurchasescanalsohelpdecreasehouseholdfoodwaste.1SpecialSupplementoftheCanadianJournalofPublicHealth2005.Understandingtheforcesthatinfluenceoureatinghabits:Whatweknowandneedtoknow.2PublicHealthAgencyofCanada.2011.Reducinghealthinequalities:Achallengeforourtimes.3StatisticsCanada.ImmigrationandethnoculturaldiversityinCanada.4ChanL,ReceveurO,SharpD,etal.FirstNationsFood,NutritionandEnvironmentStudy(FNFNES):ResultsfromBritishColumbia(2008/2009).PrinceGeorge:UniversityofNorthernBritishColumbia,2011;ChanL,ReceveurO,SharpD,etal.FirstNationsFood,NutritionandEnvironmentStudy(FNFNES):ResultsfromManitoba(2010).PrinceGeorge:UniversityofNorthernBritishColumbia,2012;ChanL,ReceveurO,BatalM,etal.FirstNationsFood,NutritionandEnvironmentStudy(FNFNES):ResultsfromOntario(2011/2012).Ottawa:UniversityofOttawa,2014;ChanL,ReceveurO,BatalM,etal.FirstNationsFood,NutritionandEnvironmentStudy(FNFNES):ResultsfromAlberta2013.Ottawa:UniversityofOttawa,2016.5AgricultureandAgri-foodCanada.2017.DraftFoodPolicyforCanada.Available:www.canada.ca/food-policy.

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6ValueChainManagementInternational.ThecostofCanada’sannualfoodwaste.20147DietaryGuidelinesAdvisoryCommittee2015:ScientificreportoftheDGAC:AdvisoryreporttotheSecretaryofHealthandHumanServicesandtheSecretaryofAgriculture.Aleksandrowicz,L.,Green,R.,Joy,E.J.M.,Smith,P.,Haines,A.(2016).TheImpactsofDietaryChangeonGreenhouseGasEmissions,LandUse,WaterUseandHealth:ASystematicReview.PLOSONE.2016;11(11):e0165797.Nelson,M.E.,Hamm,M.W.,Hu,F.B.,Abrams,S.A.,Griffin,T.S.(2016).Doyouagreeordisagreewiththeseconsiderations? StronglyAgreeSomewhatAgreeSomewhatDisagreeStronglyDisagreeDon’tKnowDeterminantsofhealth XCulturaldiversity XEnvironment XWhatdoyoulikeabouttheseconsiderations?ItisimportantthatCulturaldiversityisincluded.Culturaldiversityshouldbeconsideredintherecommendations.NutritionalguidancethatcanbetranslatedeffectivelyintheCanadianlifestylethataccountsforthediversityofethnicity,culturalbeliefs,socioeconomicstatus,foodavailabilityandpreferences,healthstatusandphysicallocationisessential.Whatdoyoudislikeabouttheseconsiderations?The“Determinantsofhealth”considerationstatesthatfoodchoicesarenotamatterofpersonalchoice.Foodchoicesareindeedamatterofpersonalchoice.Consumershavearighttomakepersonalchoicesthatwillmeettheirindividualneeds,preferencesandcircumstances.The“Culturaldiversity”considerationdoesnottakeintoconsiderationthatredmeatisastaplefoodforthevastmajorityoftheCanadianpopulationandhasbeenforgenerations.Redmeatprovidesanutrient-richfoundationuponwhichtobuildmeals.Ifculturaldiversityisaconsideration,thenredmeatsshouldnotbeminimizedintheproposedrevisionofthefoodguide.The“Environment”considerationandHCproposaldonottakeintoconsiderationtheimportanceoftheshelf-lifeofprocessedandpreparedfoodsandbeverages(i.e.extendedshelf-lifereduceswaste;foodsandbeveragesthatareaccessibleatgreaterdistancesandforextendedperiodsoftime).Focusshouldbeplacedonreducingfoodwasteandoverconsumptionoffood.Thereissubstantialevidenceandagreementthatthesechangescanmakearealdifferenceonourenvironmentalfootprint.Theimportanceofshelf-lifeofprocessedandpreparedfoodsandbeveragesneedstobeconsidered.Extendedshelf-lifereduceswasteinfoodsandbeveragesthatareaccessibleatgreaterdistancesandforextendedperiodsoftime.Also,asstatedbyHC“therearemanyinterrelatedfactorsthatinfluenceourabilitytomakehealthyfoodchoices,includingaccesstoandavailabilityofnutritionsfoods,culture,andthesocialandphysicalenvironment”.ThisiswhyitisimportantforHCtosituatetheHealthyEatingStrategywithinthedevelopmentoftheNationalFoodPolicyandkeeptheFoodGuidefocusedondietaryadvice.TheNationalFoodPolicyisthevehicletoaddressissueslikefoodaffordability,improvingavailabilityoffoodsthatareculturallyappropriateandaddressingissueslikefoodwaste.Totakeoneexample,fromanutritionalperspectiveitmaybedesiredthatCanadiansconsumemorefresh,locallysourced,wholefoods,butthismaycomewithagreaterenvironmentalfootprint.Howandwherefoodisproduced(includingclimacticzone,farmscale,soilandwatermanagement,plant/animalspecies,etc.)isamuchgreaterdeterminantofGreenHouseGas(GHG)emissionsthanthedistancefoodtravelstomarket.Similarly,homeorrestaurantpreparationandcookingofperishable,wholefoods

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mayresultinmorewater,energyandwastepercalorieoffoodconsumedthanpreparingthefoodinanefficient,highyieldprocessingplantthatimpartsextendedshelflife.Allofthesefactorsmustbeconsideredandvalidatedratherthantakingahighlevel,simplisticview.TheFoodGuideshouldfocusonprovidingmeaningfuldietaryguidancetoassistconsumersinmakingeducatedchoicesthatwillresultinabalanceddietwhilemeetingtheirindividualneeds,preferencesandcircumstances(i.e.consumerswouldbebetterservedbyprovidingguidanceaboutportioncontrolandeducationinregardtoselectingand/orpreparingfoods).Environmentalsustainabilityisanevolvingsubject.Researchershaveobservedthatmanyanalyseshaverelieduponenvironmentalimpactperpoundproducedratherthanpercaloriesupplied.Whenviewedinthelattermanner,meatandpoultryarequite“green.”Processedfoods,whethermeats,cannedvegetables,orotherproducts,lendthemselvestoamoresustainablefoodsupply.Suchproductionpracticesallowformaximumutilizationofcropyieldsandminimizethepotentialforfoodwaste.Carefulconsiderationisneededtoensurethatsustainabledietsaresuchthattheywillbeadoptedbyandareaffordabletoconsumers.Thenutritionaladequacyofpotentialfoodgroupsubstitutions,foodsafety,andculturalacceptabilitymustalsobeconsidered.Aonesizefitsallapproachisunlikelytobesuccessful.Considerableresearchcontinuestobeneededinregardtosustainablediets.ThankyouforyourinputThankyouforsharingyourfeedback–welookforwardtoreadingyourresponses.Ifyouhaveafewminutesnow,pleasehelpustoevaluateourapproachtogatheringfeedback.Pleaseanswereachofthefollowing:DidthisconsultationgiveyouanadequateopportunitytoprovidefeedbackonHealthCanada’sproposals?.Yes.No.Don’tknowDidthisconsultationhelpyoutounderstandtherevisionprocessfortheFoodGuide?.Yes.No.Don’tknowWeretheinstructionstoparticipateinthisconsultationclear?.Yes.No.Don’tknowWerethematerialspresentedtoinformyourparticipationinthisconsultationhelpful?.Yes.No.Don’tknow

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Wereyouabletoprovideallyourcommentswithintheconsultationperiod?.Yes.No.Don’tknowHowdidyouhearaboutthisconsultation?.Wordofmouth.OnsocialmediafromHealthCanadaorthePublicHealthAgencyofCanada.Nutritionblogorwebsite.Newsmedia.Updatefromfirstphaseoftheconsultation.EmailfromHealthCanada’sstakeholderregistry(ConsultationandStakeholderInformationManagementSystem–CSIMS).Other_______________________________________________________________________Didyoutakepartinthefirstphaseoftheconsultationinthefallof2016?.Yes.No.Don’tknowIfyes,wasthefeedbackyousharedinPhase1reflectedintheproposedrevisionspresentedasapartofthisconsultation?.Yes.No.Don’tknowWhatwouldyouhavelikedtoseeintheproposedrevisionstothehealthyeatingrecommendations?Guidancethatreflectstheimportanceofnutrientdensefoodsratherthanjust3nutrientsinattainingabalanceddiet.RecognitionoftheimportanceofandplansforconsumereducationthatwillresultintheuseoftheNFtwhenmakingchoicestomeetindividualneeds,preferencesandcircumstancesthatwillresultinabalanceddiet.PleaseshareanyothercommentsyouhaveabouttheconsultationprocessfortheCanada’sFoodGuiderevision.N/AThankyouandnextstepsThisprint-versionoftheeWorkbookisintendedtoassistyouinpreparingyourresponsetotheconsultationprocess.Onceyouarereadytosubmityourresponse,pleasevisitwww.foodguideconsultation.catocompletetheonlineversionofthisworkbook.Pleasevisittheconsultationswebsiteathttp://www.foodguideconsultation.caformoreinformationaboutCanada’sFoodGuideconsultation.

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ThankyouforyourvaluableparticipationinthisphaseoftheFoodGuideconsultation.Inthecomingweeks,wewillbecompilingandanalyzingalltheresponses.TheresultsoftheconsultationwillbepublishedinaWhatWeHeardreportinlate2017.Ifyouhaveanyfurtherquestions,pleasee-mailusatConsultations@ipsos.comandreferencethisconsultation.