The Role of PUBLIC EDUCATION in a Comprehensive Canadian Strategy KM Morrison, Department of Pediatrics, McMaster University

Objectives  Be aware of current knowledge of the public on obesity related themes  Be familiar with available sources of public education on obesity  Understand the role of physicians in contributing to public education  Be able to identify strategies for effective communication

Where are we now? The answer depends on whether the questions relates to knowledge of what to do – or skills of how to do it

Sanderson, 2009 Most adults in the UK are aware of the relationship of lifestyle behaviours to heart disease

Actions taken to lower personal and family members’ risk of heart disease in the previous year. Mosca L et al. Circulation 2006;113: Copyright © American Heart Association Survey in 1008 women -- USA

Facilitators for implementing change?  “Awareness of personal risk” Mosca L et al. Circulation 2006;113:

Barriers to NOT implementing change?  “Media is too confusing”49%  “Health is determined by a higher power” 40%  “Caretaking responsibilities”37% Mosca L et al. Circulation 2006;113:

 According to Angelo A. Alonzo, professor of medical sociology, Ohio State University, information overload may be one reason why people choose not to adopt healthier lifestyles. Ohio State University  Due to the vast amount of medical information inundating the public every day….  "Health educators may well face a significantly desensitized population, segments of which are immobilized by fear, indecision, and confusion."

Sources of information on healthy lifestyle INTERNET 23 MILLION HITS Advertisements COMMUNITY Entertainment PRINT MEDIA

Influence of social connections on obesity development Christakis, NEJM, 2007 Framingham Offspring Study Utilized information at each of 7 visits relating to family members and friends

Influence of type of social connection

Influence of geography

Sources of information on healthy lifestyle INTERNET 23 MILLION HITS Advertisements COMMUNITY Entertainment PRINT MEDIA PHYSICIANS? Hippocrates: “let thy food be thy medicine”

Canadian’s experience Kirk etal  Telephone survey of 2004 Canadians conducted by Ipsos Reid – March/April 2009  80% urban, 20% rural dwellers from across Canada  32% were overweight, 21% were obese based on self reported height and weight  40% of overweight thought their weight was “about right”

Canadian’s experience Kirk etal  50 – 71% of overweight or obese adults had tried to lose weight in the preceding 12 months....  Only 13% of overweight and 35% of obese had asked a physician for help with weight management in the last 12 months (25 and 58% ever)  30% of overweight and obese adults had been advised by their physician to “lose weight” Kirk SF, Chronic Diseases and Injuries in Canada, 2012

Copyright © American Heart Association Parental perception of child’s weight status Measured BMI in Canadian school age children n=384 He et al Canadian Family Physician

Parental perception of weight status in 2 – 5 year olds – Northern Ontario Do you think your child is underweight, normal weight or overweight? Do you think your child’s weight might impact their future health? Tijssen,CPS, 2011 UNDER NORMAL OVERWEIGHT

Sharma AM. M, M, M & M: a mnemonic for assessing obesity. Obes Rev. 2010;11:808-9.

Educating the Public – Policy Implications  “For the most part however, the reliance upon scientific and usually quantitative knowledge by health promoters… has led to an emphasis on lifestyle issues that potentially detract attention from the political and socioeconomic issues that influence health and well-being” --Toba Bryant, Health Promotion International, 2002  “although individual behaviour does contribute to health and disease, social organization is perhaps a more powerful influence” --Freudenberg, Health Education Monographs, 1978

Spiral of causation CHILD FAMILY COMMUNITY INDUSTRY GOVERNMENT(s)

Knowledge to advance policy change  Development of a fundamental new direction in policy  Influenced by knowledge  Requires knowledge of different types – and from different groups Paradigmatic policy change

Management: One step at a time!  GOAL SETTING – Must be realistic!  Focused on behavioural change!

Be part of the solution!  Support safe walking (School bus, shopping, recreation, community)  Be a voice for community  Be a voice in schools  Be a role model for all the children in your life!