Industry group lobbied government three dozen times on what should be included in its advice to Canadians on eating well. Image: Health Canada. [Editor's note: In this ongoing series, Grow, Eat, Learn: School from the Plate Up, Tyee Solutions Society reporter Katie Hyslop visits farms, schools, full-length mirrors and our own kitchen cupboards to examine how we lost our way when it comes to feeding our kids, and how we can get back on the path to wholesome, healthy eating. Find the series so far here.] Whether you're familiar with Canada's Food Guide or not, it has a big impact on the food you eat. Each new edition of the guide "becomes our nutritional backdrop, our nutritional consciousness as a nation," says Dr. Yoni Freedhoff, medical director of the for-profit Bariatric Medical Institute and one of only three Canadian physicians certified as an obesity specialist. All levels of government depend on the Health Canada-produced guide as a basis for feeding people in public institutions like hospitals and schools, and for public health messages meant to encourage us all to eat what will keep us well. In British Columbia, it's also the basis for the guidelines that dictate what foods provincial schools may serve students -- including many of the initiatives reported on in this series -- and what kids learn about health and nutrition in school. Given the faith invested in it, you might assume that Eating Well With Canada's Food Guide, as the 2007 and latest version is called, has been meticulously researched and vetted, earning its reputation as the pinnacle of nutritional information available in Canada. But according to Freedhoff, you would be wrong. "We don't have a food guide that reflects our current understanding on the impact of diet on disease," the obesity specialist said. "And that seems backwards in country where diet and weight-related illnesses are the number one preventable causes of death." Rates of both Type 2 diabetes and obesity in Canadian children have been going up. American researchers anticipate that the elevated risk of chronic diseases developing in children with obesity over their lifetimes could result in them having a lower life expectancy than their parents' generation. Plus, the food industry has a seat at the advisory table the government convened to create the guide. Even after it was last updated, industry groups continued to lobby Hasan Hutchinson, director general of Health Canada's Office of Nutrition Policy and Promotion, the office responsible for producing the food guide. Last spring Freedhoff squared off with Hutchinson, who holds an ND in naturopathic medicine and a PhD in quantitative genetics, in a public debate about whether the guide made Canadians fat. The event was sponsored by the Canadian Obesity Network and the University of Ottawa, and is available online. During the debate, Freedhoff used data showing the amount of food we consume and how our obesity rates have been going up since 1992. That's the same year an updated version of the guide debuted, recommending more food than the 1982 version had. During the decade in between, the guide's food consumption and obesity levels had remained fairly constant. Hutchinson replied that the food guide is not intended to help people lose weight, but rather maintain their weight. An audience show of hands at the end of the debate showed most in the room -- including some Health Canada employees -- sided with Hutchinson. But another vote showed most hadn't changed the position they took on the guide before the debate even began. Not surprisingly, Hutchinson still stands behind the guide. In September, he said that prevention of chronic disease is exactly what the guide was designed for, and its main reason for existence today. "Unhealthy eating is by far the most important component in terms of being a risk factor for chronic diseases," Hutchinson agreed with Freedhoff, listing obesity, Type 2 diabetes, heart disease, some cancers and osteoporosis as examples. "[Unhealthy eating is] more important than smoking [as a cause for chronic disease]," he said, "and much, much more important than physical activity." Past its best-before date? Governments and individual Canadians aren't the only ones who make use of the guide. In fact, the food industry probably uses it more than any other group. "It serves as a marketing tool," Freedhoff said. "Food manufacturers will market on the basis of the recommendations in the Food Guide." Why do boxes of sugary cereal boast about the amount of your daily-recommended intake of vitamin D found in just one bowl? Because the Food Guide bases its recommendations on the idea that access to individual nutrients matters more than the type of food we eat in order to get them. It's that assumption, Freedhoff argues, that leads to unhealthy diet decisions. It's a mistake, he says, to equate proteins acquired from beans, fish and nuts with those from red meat, which is linked to heart disease and cancer, or to avoid healthy saturated fats in favour of low-fat, high-sugar processed foods, because of false links between such fats and heart disease. In another example, the guide urges Canadians to choose foods "low" in trans fats. In fact, that choice is vanishing anyway, thanks to a U.S. phase-out of trans fats from food produced there, and its elimination by many processed-food companies like Frito-Lay, because of negative associations with trans fats' health consequences. In 2009, Health Canada abandoned a plan its own trans-fats task force recommended to enforce a reduction of trans fats found in foods served in restaurants or bought in stores. Even the amount of food the guide prescribes for a daily diet is off, Freedhoff argues. Since it recommends portions of its food groups that provide the maximum necessary daily calorie intake, but doesn't account for other things that most of us eat as well but are not included in the guide, like ketchup or chocolate, following its rules will make most people gain, not just maintain, weight. Freedhoff says the guide should recommend smaller portions closer to those in the 1982 Food Guide. "The Food Guide should be a vehicle that people can look to for an evidence-based reflection of [a diet to prevent disease], and the fact that you can't do so is disturbing and distressing," he said. Industry influence or 'urban myth' According to Hutchinson, Health Canada's researchers are continually reviewing the evidence the guide is based on in light of new scientific data. They also examine how the guide is being used by Canadians, governments and food companies, and whether food supplies or consumption patterns have drastically changed since the last edition in 2007. One complaint the agency is trying to fix, Hutchinson says, is that serving sizes recommended in the guide don't always match those on food nutrition labels. Health Canada will launch a nutrition facts education campaign next spring to address the issue, he adds. While Health Canada's evidence review could result in a new guide someday, there are no plans for a new one at the moment. "When you're trying to get people to change behaviour, you have to have some consistent messaging over time, otherwise people get confused over what they should be doing," Hutchinson said. Why does Freedhoff think the guide got it wrong? He believes it has to do with the chefs invited into Health Canada's kitchen. In 2006, Freedhoff wrote in his blog Weighty Matters that a quarter of the members of Health Canada's "Food Guide Advisory Committee," tasked with updating the guide, had connections to Canada's food industry. They included representatives from the B.C. Dairy Foundation, the Vegetable Oil Industry of Canada, and Food & Consumer Products of Canada, which represents over 100 food companies in Canada including Kraft, Campbell's, Dole, Hershey's and Kellogg's. "[The food industry] would be very happy seeing terms like 'limit' rather than 'avoid' trans fats," he said. "And very happy seeing the Food Guide recommend minimums of dietary consumption and, quite frankly, recommendations for the consumption of huge amounts of food." Health Canada's Hutchinson challenges that conclusion. He says the Food Advisory Committee was just one of three groups created to update the guide. A "Dietary Reference Intake Expert Advisory Committee," composed of academics and provincial and federal public servants, had a bigger role, he said. It "created the whole food intake pattern" for the guide and had "absolutely no industry involved at all whatsoever. It was entirely made up of academics and public health nutritionists." An "Interdepartmental Working Group Committee" was the third group involved in reviewing the guide. It was composed of public servants from other federal agencies, including Aboriginal Affairs and Northern Development, Agriculture and Agri-Food, the Department of Canadian Heritage and the Canadian Institutes of Health Research (CIHR), which Hutchinson represented on the committee himself, as assistant director of the CIHR's Institute of Nutrition, Metabolism and Diabetes at the time. The Food Guide Advisory Committee's role, Hutchinson said, was "strictly giving advice on how to communicate the [food] pattern in a clear and concise manner" to consumers. Most of the committee members hailed from academia, provincial governments and public health backgrounds. "It's sort of an urban myth more than anything else that industry had a strong influence on the [food] pattern," he insists. Yet industry contact with Hutchinson's office didn't end with the committees. The Retail Council of Canada, Food & Consumer Products of Canada and Restaurants Canada all registered to lobby Hutchinson between 2008 and 2013. The most frequent contact came from Food & Consumer Products of Canada, whose representative sat on the food guide's advisory committee. That group communicated with Hutchinson's office 36 times over an 11 month period between November 2009 and September 2010. Freedhoff also takes issue with the fact the guide's final approval rests with the minister of health, a politician with a constituency to please. Food, in every aspect from field to restaurant service, makes a big contribution to Canada's economy, accounting for eight per cent of the country's gross domestic product. So if medical advice about the negative health impacts of eating red meat, for example, locks horns with Alberta ranchers, Freedhoff believes the cows -- or at least their owners -- will win out. "Politicians' jobs are to get re-elected," he said, referring to the health minister. "So as a consequence, their recommendations in some cases will reflect that." Hutchinson maintains GDP was never discussed in the meetings he attended with other federal public servants. Instead, they talked about the scientific evidence linking food and chronic diseases, the nutrient distribution in the different food patterns Health Canada proposed, and how to best communicate that information to the public down to debating whether the guide should be six or eight pages long. Dieting well with Canada's Food Guide? With no set schedule for updating the Food Guide, the time between past updates has ranged from two to 15 years. Its U.S. counterpart, the Dietary Guidelines for Americans, by contrast, is required by law to be updated and republished every five years. Canada's biggest physician group, the Canadian Medical Association (CMA), praised the existing guide when it came out in 2007. But even then, the group expressed a wish to see a new version every three to five years, passing a resolution at its general council meeting that year calling for regular updates that consulted CMA members. While provincial and federal health ministries were involved in the guide's creation, no medical associations were consulted. This past August, the association passed a motion that Freedhoff authored, endorsing a request to government for revisions. "Despite efforts to date, the food guide has not been renewed since 2007. Our understanding of the impact of diet on chronic disease is evolving, as is our understanding of the impact of messaging on consumer behaviour," reads the rationale behind this year's motion. "As examples of changing evidence, sugar is in the forefront with both the American Heart Association and the World Health Organization having provided upper limit guidelines since 2007." There are no sugar guidelines in Canada's Food Guide, but a recommendation to "limit" the amount of sugar, fat and salt consumed daily. The Centre for Science in the Public Interest voiced similar concerns to Freedhoff's in preliminary feedback to Health Canada on an early draft of the current food guide in 2004, including issues with equating the health benefits of red meat with that of other protein options, and maintaining the larger serving sizes from the 1992 guide. Health Canada may not appreciate Freedhoff's criticism, but he's been heard by federal members of Parliament. In September 2006, the government-dominated Commons Standing Committee on Health invited him to testify about the guide's impact on childhood obesity. He told the committee at the time that nutritionists he worked with at the Bariatric Medical Institute advised patients not to follow the guide if they were trying to lose weight. "It simply does not reflect medicine's understanding of the role of chronic disease, and recommends far too many calories," he testified, adding the amount of food the guide recommends Canadians eat daily "increased significantly" between the 1982 and 1992 versions of the guide. Freedhoff also took exception to the minimal guidance the guide contains on how many calories to consume other than vague language like "try not to eat too much more or too much less," "be aware of your portion sizes'" and "choose foods that are lower in calories." Be more like Brazil Hutchinson says that similarities between Canada's guide and those of other countries, particularly in the Mediterranean region, lead him to the conclusion his researchers must be doing something right. But Freedhoff would rather Hutchinson's team look to Brazil. Its food guide has eight food groups versus Canada's four, with one reserved for sweets. It recommends cutting out all processed foods entirely, even warning Brazilians against food industry advertising -- something critics have begged the Canadian government to do for some time, especially when that advertising targets children. Brazil's guide not only says what foods to eat, but how to eat them. It suggests entire meals instead of recommending portion sizes, and praises a return to old-fashioned habits like cooking from scratch and eating meals together with family or friends. "I think this is where we need to go," the obesity expert argues. "I don't think we're going to solve our problems with diet and weight with boxes of processed foods. I think we really do need, as a species, as a society, to re-cultivate the love affair with our kitchens." Hutchinson counters that Canada's guide already has a lot in common with Brazil's, including suggesting braising, baking and poaching over frying foods. The Brazilian guide, he said, has "almost word for word what [our guide] said with respect to having foods with little or no added fat, sugar or salt." He says it's not the guide's role to tell you how to eat: that's the purpose of Health Canada's Eat Well campaign instead. Now three years old, Eat Well focused its first two years on encouraging us to consume less salt. Health Canada rolled out TV spots, print and digital media advertising, created in co-operation with health ministries in Ontario and British Columbia and the Dietitians of Canada, and even in-store events with grocery stores, to target people where they bought their food. Fact sheets provided advice on how to shop for food, how to cook it, and how to eat out at restaurants, without consuming too much sodium. Since then, the campaign has shifted to children's caregivers, advising them on how to provide the most nutritious meals for kids' growing bodies. (Freedhoff complains that that information isn't contained in a single document like Brazil's, requiring Canadians to look further than the guide for healthy eating information.) Whether those campaigns, or the Food Guide itself, are having a real impact on our food choices may become clearer soon. Health Canada plans to join forces with Statistics Canada next year to ask 25,000 Canadians what they ate over the previous 24 hours. It will be the third Canadian Community Health Survey on nutrition since 1972, Hutchinson said, and "will give us the type of information we need to know -- what are people actually eating right now." The results won't be in until 2016-17. But when they are, we may see a new guide that incorporates some Brazilian food guide flavouring -- or traditional Canadian meal making -- into its recommendations for our daily diets. Wednesday, the next story in the series: Are we too worried about childhood obesity?