August 4, 2016
The Honorable Dr. Eric Hoskins
Minister of Health and Long Term Care
Hepburn Block, 10th Floor
80 Grosvenor St.
Toronto, ON M7A 2C4
RE: Ontario Regulation 50/16 – Proposed Regulation Amendments under the Healthy Menu Choices Act, 2015
Dear Minister Hoskins,
Dietitians of Canada (DC), Ontario Society of Nutrition Professionals in Public Health (OSNPPH) and Ontario Public Health Association (OPHA) would like to congratulate the Ministry of Health and Long Term Care for your ongoing work with the Healthy Menu Choices Act, 2015.
Dietitians of Canada represents the national voice of Registered Dietitians. OSNPPH represents Registered Dietitians that work in Public Health across Ontario. OPHA represents the voice of public health professionals from various disciplines working in public and health promotion throughout Ontario and is also the host of the Nutrition Resource Centre. Together DC, OSNPPH and OPHA provide extensive nutrition expertise, evidence and practice-based knowledge and experience to support nutrition-related healthy public policy. We are very much aligned with your Ministry’s work to achieve the health and well-being of all Ontarians.
After a review of menu labelling research, best evidence in many international jurisdictions and consultation with a broad range of our expert nutrition stakeholders, we are pleased to provide input into your Ministry’s proposed regulation, specifically related to the contextual statement that would be posted on menus.
Together DC, OSNPPH and OPHA recommend the following contextual statement:
Average daily calorie needs are as follows, however, individual calorie needs vary:
· Adults and Youth (ages 13 to 18): 2000 calories
· Children (ages 4 to 12): 1500 calories
Our three organizations believe the currently proposed calorie ranges are too broad to be meaningful and would not achieve the intended purpose of enhancing consumers’ ability to appropriately use the contextual statement to make informed menu choices. As nutrition experts and registered dietitians, we recommend providing one single reference value (instead of a range) as it is much more meaningful and understandable. Similarly, readjusting the age groups of Children and Youth, as we have recommended, increases the homogeneity within these groups and reduces the caloric variability, thus making the reference more meaningful. This is also consistent with how Health Canada and the US FDA provide general nutrition advice, and nutrition and menu labelling information.
Further, we recommend removal of 2 and 3 year olds from the contextual statement due to the lack of evidence and jurisdictional support for their inclusion. In fact, best practice supports feeding children based on hunger cues rather than pre-determined caloric values. In turn, the age range we recommend for children (ages 4 to 12) will make it more meaningful for parents who purchase meals for their children. It reflects the typical age range that food service establishments have set for children’s meals (under the age of 12, but not intended for children under 3). Additionally, this recommendation is in line with the USA’s federal legislation which documents a focus on the child’s menu in its Federal Register as a key component to decisions made around the child’s contextual statement.
Simplifying the contextual statement will reduce confusion, the risk of sending mixed messages and the risks of unintended consequences when educating the public around nutrition, particularly in messages that include children. To maximize the public health impact of this policy, we encourage your Ministry to be mindful of the broad range of literacy levels among consumers by adopting an approach to nutrition communication that ensures health equity. Low nutrition literacy is a common phenomenon well documented in the literature.
Finally, this recommended alternative does not change the spirit of the proposed regulatory changes but rather provides a more succinct, understandable and meaningful statement. It is specific enough to apply to the general population and supported by strong evidence, while meeting the principles of contextual statement design. This simplified approach has shown to be effective in increasing consumers understanding of calorie information and facilitating change in consumers’ purchasing behaviors. Additionally, the suggested alternative aligns with foodservice operators’ preferences, since it would be easier for them to implement and requires less menu space.
To achieve the intended goals of this legislation and to minimize the risk of unintended health consequences, we strongly recommend that a comprehensive public education campaign be undertaken to support consumers’ use of posted calorie information, during the implementation period and beyond. Similarly, we recommend a comprehensive, coordinated, well-resourced and continuous evaluation strategy be implemented to assess the impact and inform legislation and education.
In the attached document, we have included evidence-based rationale and considerations underpinning our recommendations. We appreciate being able to convey the concerns and expertise of our members. In addition, we would welcome the opportunity to further discuss our recommendations, as well as, the role that our organizations can play in supporting the implementation, education and evaluation of the Healthy Menu Choices Act, 2015.
Linda Dietrich Evelyn Vaccari Pegeen Walsh
Regional Executive Director, Co-Chair, Executive Director,
Dietitians of Canada OSNPPH OPHA