Canadian pediatric hospitals part of the problem or solution?

Over the last 30 years, the proportion of children who are overweight or obese has risen dramatically with the most recent data indicating that 26% of Canadian children and youth are categorized as overweight or obese. Fruit and vegetable intake is inversely associated with obesity and the Canadian Community Health Survey indicated that 70% of Canadian children are not meeting the recommended daily intake of fruit and vegetables.

Nation-wide survey

Working in partnership with local Canadian Paediatric Society (CPS) healthy active living (HAL) champions and the Canadian Association of Paediatric Health Centres (CAPHC) Liaisons, a nationwide survey was conducted in 2006-2007 to identify healthy eating, physical activity, and smoking cessation practices in all 16 Canadian Paediatric academic hospitals in Canada. The full and complete report of the survey results is available here (http://www.pulsus.com/journals/pdf_frameset.jsp?jnlKy=5&atlK y=9832&isArt=t&jnlAdvert=Paeds&adverifHCTp=&sTitle=Practising what we preach: A look at healthy active living policy and practice in Canadian paediatric hospitals, Pulsus Group Inc&HCtype=Physician).

Healthy food options

The objective of this study was to obtain an overview of HAL Policy and practice in Canadian paediatric hospitals. Overall, policies addressing healthy eating and/or physical activity promotion were present in 50% of hospitals with greater focus on nutrition. Wellness committees had been created in half of the hospitals, most of which had been recently established. Healthy food options were available in cafeterias, although they were often more expensive and fast food outlets were present in 75% of surveyed hospitals. In-patient meals were designed by dietitians but half offer less nutritious replacement ‘kids’ meals upon request.

Healthy eating policies

Options for play available to in-patients and outpatients were primarily sedentary, screen-based activities and crafts predominating over active play. Physical activity promotion for staff focused on reduced membership fees to fitness centers and classes. At the time of the survey, 50% of hospitals reported having policies regarding one or more elements of healthy eating (inpatient meals, cafeteria food, fast food sales) or physical activity promotion for staff and/or patients. Cafeteria, fast food outlets, and vending machines were accessible to members of the hospital community to procure food, with designated meal plans available to patients. Although all hospitals offered unhealthy food items, one could select an alternative healthy item in most facilities (e.g. replacing fries with salad). However, the healthy substitution was often more expensive. Fewer than half of the paediatric centres offered childsize meal portions but, in all hospitals with this option, the child size item was less expensive. Inpatient meals were designed by dietitians in all surveyed institutions with virtually all Following Canada’s Food Guide for Healthy Eating. Although 75% of hospitals offer low fat options – over half serve replacement kids meals upon request (hot dog, hamburger, and fries).

Policy development needed

In essence, Canadian paediatric hospitals do not adequately promote HAL for patients and staff. Findings suggest further effort is required to create necessary healthy lifestyle modifications in these institutions through CPS-CAPHC-led policy development and implementation initiatives.

Responsibility to promote health

Public perception suggests that hospitals have a responsibility to promote health, wellness and disease-prevention. Accordingly, institutional policy, long range planning and resource budgeting should be in place to address this issue. On a positive note, many Canadian hospitals are starting to develop wellness committees and establish cafeteria nutrition education programs and other promising programs to promote some aspects of HAL. For example, a similar Canadian survey from 2004, revealed that only 27% of institutions reported having dietitian time dedicated to overseeing and promoting healthy eating in the retail cafeteria and 17% had a written nutrition policy or philosophy suggesting that some limited progress has been made. Unfortunately, few guidelines have been created and implemented to date and there is an absence of a policy framework required to adequately address the major obesity-promoting factors. Only 30% of hospitals currently use dietitians to monitor compliance with national guidelines and the availability of fast food and low nutritional value vending machine snacks in hospitals is particularly disconcerting as it sends an unhealthy message to the community and may prompt those who require hospital-based care and their families to eat nutritionpoor food and drinks. Indeed, past research has shown that children who eat from vending machines or at fast food restaurants are more likely to consume foods higher in fat and drink sugarsweetened beverages resulting in greater weight gain.

Strong policy framework

Canadian paediatric hospitals are working towards promising policies and programs to promote some aspects of HAL for patients and staff but a more comprehensive and systematic approach is needed. This study indicates the need for a strong Policy framework to create and implement guidelines regarding healthy nutrition, physical activity and smoking cessation for patients, their families and staff. Specific areas that require urgent attention are the common practice of fast food vending in hospitals and the pervasiveness of sedentary activities for patients.

2011 Noni MacDonald Award winners

Dr. Solh and Dr. Adamo have been awarded the 2011 Noni MacDonald Award. This award is given annually in honour of the founding editor of Paediatrics & Child Health, the peer-reviewed journal of the Canadian Paediatric Society. It recognizes an author(s) whose article, published in Paediatrics & Child Health, has positively affected paediatrics, such as by raising awareness of an issue, presenting new scientific research, or instigating or potentially instigating change.

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