The cost of calories: It's expensive to eat healthily

It began as a simple question: Is it diet or lack of exercise that contributes most to weight, and which of the two is contributing most to the obesity epidemic in Canada? Then Cassandra Golondrina, a single mom of five and full-time student on social assistance, allowed writer Catherine Mitchell and photographer Ruth Bonneville into her home to pry into her finances and her life.

They got a snapshot of how Golondrina, who has had a rough life and a tough relationship with food, managed buying groceries, preparing meals and keeping the four children who live with her fed; getting it done every day on a budget designed to defeat. In some ways, Golondrina is not the typical Canadian battling weight issues and keeping her family healthy because of her personal circumstances. But because body weight is deeply personal, every war is different.

 

IT’S 8 a.m. and the two youngest in the Golondrina household hop up onto the bar chairs at the brand-new kitchen table for breakfast.

"Two or three, at most," Cassandra Golondrina reminds her boys, Rhys, 9, and Keagan, 11. The boys dump packets of flavoured instant oatmeal into a bowl, soaking the flakes and fine, sugared powder with boiling water.

They drink tea. Keagan grabs a packet of flavoured-popcorn snack, too.

"Would you believe I washed this floor last night?" Golondrina, 38, says leaning against a counter crowded with dishes, clean and dirty.

Golondrina doesn't eat.

The mother of five doesn't eat breakfast or lunch usually, although she will pack a bag of trail mix to keep her going at Red River College, where she is a full-time student. Cigarettes get her through the day.

The family is on social assistance. Money is tight. Sometimes, when food is running low in the Gilbert Park home, Golondrina might skip dinner.

That dinner feeds four other mouths; eldest daughter Paulina, now 18, has just recently moved out. While it's nice to see kids spread their wings, the rite of passage for the young adult has also reduced the family income. Golondrina must now make do on social assistance and child tax benefit cheques that total $2,674.20 per month.

"When things are tough, my kids eat and I don't."

 

 

And yet Golondrina is a big woman. She recognizes the toll the weight has taken on her health, and she worries about her children's health, concerned about what a diet that is often of lesser-quality food will do to them.

She is most worried about Keagan, who is tough to pry away from the computer and resistant to the idea of exercise. He is getting big, too.

Keagan and Golondrina are emblematic of a worrisome trend in Canada. We are packing weight on in dangerous amounts. Children have gotten bigger, too, and teens are putting on the weight at faster rates than adults.

 

How big are we now?

Kids are taller and heavier than a generation ago, but the growth is not proportionate. They have more body fat, they are less fit and obesity is an issue of real concern in adolescents and teens.

Since 1979, Canada's line graph on weight has risen steadily, but the biggest gains were made in the earlier years. In 2009, 24 per cent of adults were obese and 37 per cent overweight, compared to 14 and 35 per cent in 1979.

The rapid rise in obesity is alarming because the very heavy are significantly more prone to health problems.

Some children are obese now at two years of age, but the area of greatest growth has been among teens, whose obesity rate tripled to nine per cent between 1979 and 2004, Statistics Canada reported.

Manitobans, in particular, are heavier than the average Canadian. An analysis released this year by the Manitoba Centre for Health Policy, which tried to correct for weaknesses in self-reported weight and height surveys, concluded 73 per cent of men and 60 per cent of women in this province are obese or overweight.

There is some evidence the rise in obesity is levelling off, but if the trend were to continue, a whopping 70 per cent of Canadians will be overweight or obese by the time babies today are young adults.

Obesity, considered a public health epidemic, is making Canadians ill, putting daunting pressure on health budgets and fuelling diseases that are killing Canadians far too young. We know Canadians are eating more, eating less-healthy foods and are more sedentary.

Also, those in rural areas are more likely to be heavier than city-dwellers -- about 70 per cent of rural Manitobans are overweight or obese, particularly those who live in northern Manitoba.

There are a number of weaknesses in surveys that track weight and obesity, chief among them, most rely on "self-reported" data. People typically are not good at getting their facts straight. They shave off the pounds by about five per cent, which throws off the body mass index calculations.

Further, almost all surveys do not pick up data from First Nations reserves, where rates of diseases connected to obesity are high.

But in 2011, a StatsCan survey indicated a significantly higher obesity prevalence among First Nations people on reserve.

 

How can people stretched for cash be overweight?

Golondrina can tell you how.

She is an intelligent, hard-working mother raising her children to be healthy and self-sufficient.

Walking into her house and watching the family's routine challenges preconceptions and prejudices of how the poor live and manage their money on a budget that, to be kind, is defeatist.

"My kids have always been fruits-and-vegetable children."

Golondrina works in community gardens each summer, harvesting good stuff for her table.

She can tell you all about the good -- fresh fruit and vegetables -- and the bad -- slabs of high-carb lasagna, pizza pockets -- foods she stocks in her Gilbert Park townhouse. She knows the risks of a high-fat, high-salt diet.

But the reality is, there is lots of that stuff in her house. And that's hard for Golondrina to swallow.

Her kids love eating. The young ones, especially, eat the "ready-made" foods and treats that are high in calories.

So stop buying them, you say?

Golondrina wishes it were so simple.

She defends her choices at the Giant Tiger at Logan Street and McPhillips Avenue, explaining why, alongside the bag of apples, the carton of nectarines, the tray of pork chops and the four-litre jug of milk, she buys the pouches of Mr. Noodle, the two-kilogram lasagna heavy on processed cheese and pasta but light on protein, the bag of meatballs, frozen pizzas and sugary treats.

Sandwich slices that look suspiciously like cheese-type food, $1 for a pack of 16 slices -- how is that possible?

"You get more calories for your money with cheap crap than with healthy food," she says. "It's sad."

She says the lasagna at Giant Tiger costs $9, and making one from scratch easily runs $12 -- that's $3 lost, $3 she could spend on eggs.

"Sometimes it's chicken nuggets and french fries: $6 and there's dinner."

When you're filling mouths on welfare, you go for capacity. The worst thing, she says, is hearing kids whine that they are hungry.

"It's wherever my dollar stretches the most, most of the time. If you can have your child go to bed not hungry or not healthy, you'll pick not hungry."

She considers it a minor miracle she can put enough food on the table for her family of five, that she finds room in the budget for that and all the other necessaries of life.

As for herself, Golondrina's life has been marked by her relationship with food. When she was young, her father watched her every mouthful, constantly warning her about getting fat. Later, she moved in with her mother, a large woman, and ate the wrong stuff, usually in front of the TV.

When she was a high school athlete, she wrecked her knees then stopped playing sports. Her knees still hurt, so weight-bearing exercise is out.

Her hectic schedule -- racing home at day's end to pick up the kids from daycare, run errands, start supper, clean up and take in the community meetings that make Gilbert Park an "amazing" place to live -- means she has little time to cook from scratch.

Instant breakfasts are easier in a chaotic kitchen, and suppers frequently are fast -- popping the cheap lasagna or bag of chicken breasts in the oven takes a fraction of the time to prepare either of these dishes fresh.

Like their mother, Victor, 14, Patricia, 16, and Paulina, the 18-year-old who moved out recently, do not eat breakfast.

 

What is driving Canada's weight problem -- diet or lack of exercise?

Golondrina says most of her kids are active, which she recognizes is key to health, and can keep the weight off.

Keagan, however, is a challenge. He is a sedentary kid, but does want to play football, which she can't afford.

Her kids snack -- she calls them grazers, always eating. They'll graze on vegetables with dip, but also prepared snack foods -- pizza pockets, chocolate milk, crackers and sugary treats.

John McGavock, professor of kinesiology at the University of Manitoba, says the pivotal factor in Canada's weight problem is diet, what and how much we eat. It is easy to put on the pounds, and it takes regular exercise to counteract the effect just 100 extra calories a day will have over the course of a year.

Most of us don't have that kind of discipline. Remember all those resolutions to get outside and walk every day?

Here's the math: 3,500 calories add up to one pound of fat. So in less than two weeks, an extra 350 calories a day will put a pound on your butt. Even an additional 175 calories a day -- a couple of slices of toast with margarine -- lards it on in three weeks. Figure that over a year: 18 pounds!

And that, in a nutshell, is the problem.

Those little extras every day are unforgiving for the vast majority of us, which is why when we go from active high schoolers to sedentary office workers, we put on weight even if we don't eat much more.

With more "ready-made" foods being served at the Canadian table, and with more of us eating routinely at restaurants, we are consuming more flavourful foods. That flavour typically comes in fat (butter, for example, in sauces), sugar or salt.

Next time you order a California chicken sandwich for lunch at your favourite restaurant, ask for a nutrition guide. It contains 476 calories more than the chicken salad sandwich you could have paper-bagged to work.

The research surveys on exercise vs. diet as they relate to weight are not really good. A number of studies have said a sedentary lifestyle is strongly co-related to obesity. But there are glaring weaknesses in them: They are not good at describing lifestyle and most do not look at what someone sitting in front of the TV is eating.

In trying to measure the quality of a respondent's eating habits, some surveys ask about consumption of fruits and vegetables, as a rough proxy for a healthful diet. They don't ask whether the broccoli was covered in cheese sauce or a whole lot of high-cal food was being eaten alongside the peas and carrots.

French fries are a vegetable. Heck, according to the United States Congress, pizza is a vegetable. (Americans, on average, are heavier than Canadians.)

McGavock points to a study that actually looked at children's TV and screen time. A 2008 study in the Journal of Pediatrics and Adolescent Medicine reported that in overweight children four to seven years old, those who were dragged away from the screen didn't exercise more, but they ate less. And they dropped pounds.

Some of the findings explain how, as a nation, Canada is gaining weight. The obesity trend is not really tied to income, the Manitoba Centre for Health Policy found earlier this year when it pulled apart who is putting on the pounds. This is at odds with StatsCan's surveys.

Golondrina's kids are typical.

"My kids eat lots. I gotta feed them. It's probably the biggest expense I have."

The two youngest sometimes eat breakfast at daycare, where they also get their lunch. But when they are home, they snack. Those snacks might be vegetables and dip, but they are also crackers, popcorn balls, litres of chocolate milk.

"The fruit snacks go immediately," she says.

"The truth is she's right; those (less healthy foods) are the cheap foods," concurs Kay Watson Jarvis, a dietitian in Calgary who has worked on a healthy eating program for the provincial health authority.

"Healthy choices are the most difficult because they are the most expensive."

At night, before bed, the boys will eat again. Sometimes it's instant oatmeal or canned vegetable soup. Tonight, the pizza pockets come out.

The babies go to bed full.

 

Some of Golondrina's kids are slim. How can children be different sizes, same mom, same home?

Even in the same household, people have different eating habits. Just ask Golondrina.

This is a mother who breastfed all her children for as long as circumstances permitted -- her eldest was breastfed for four months because Golondrina was forced to go back to work. Patricia was breastfed for a year; Victor was breastfed for two years because he was allergic to cow's milk. Keagan, a year; Rhys was four days old when Golondrina, who was in school at the time learning carpentry, went back to the classroom and to her two part-time jobs. She breastfed him when she could.

At the breakfast table, Rhys never stops moving, and he doesn't finish his bowl of instant oatmeal.

The science of diet, metabolism, genetics and exercise vs. sedentary lifestyle is developing, and each revelation underscores how much we don't know. But research that pinpoints the determinative factors is limited by the data that can be collected.

It would be unethical to set up a prospective study that assigns a healthy diet to one group, over the long term, and assigns high-fat, high-cal food to another, with exercise and activity levels similarly controlled for others.

And remember, Canada is hobbled in understanding the dimensions of its weight problem because data from reserves, where some of the highest food costs in Canada prevail, are missing.

That cripples the ability to design interventions that might control generational weight and disease problems.

 

Is it simply what and how much we're putting into our mouths?

Yes and no.

There was once in vogue a theory that genes and natural adaptation were dealing a heavy hand to indigenous people living in a time of plenty. It was dubbed the "thrifty gene." The theory postulated that tribal folk, who for generations lived with feast and famine cycles, were genetically predisposed to hoard fat. Once they lived away from the land and bought from the grocer's shelves, their bodies naturally grew fatter.

That theory is dubious. It takes hundreds of years for genes themselves to adapt to environment and the occasional famine does not cut it. But another discovery that relates to feast and famine implicates something more subtle and complex -- genetic expression -- is at play.

Heather Dean, a U of M professor of pediatrics and pediatric endocrinology, says the thrifty gene theory was simplistic. The recent and rapid rise of Type 2 diabetes -- "which used to be an old person's disease" -- in children indicates that genetic change is not at the core of the problem. Same for obesity levels; Dean points out that historically about five per cent of children were obese. It's almost double that now.

Dean's work rides on a new developing strand of scientific inquiry, one that suggests that some people may have a much more limited ability to control their weight by what they eat and how much exercise they get.

Called epigenetics -- not so much the genes we carry, but how they are programmed during fetal development -- it is revealing that some children are biologically predisposed to obesity and disease.

This new thinking on the developmental origins of health and disease got a huge boost from a study of the babies of women who were pregnant during the Dutch Hunger Winter. In the winter of 1944-45, the Dutch in western Netherlands were starving as the Second World War was in its final throes. At one point, people were given daily rations of 400 calories. Babies born to these mothers were followed up decades later by various researchers and found to have higher incidences of various health conditions. Interestingly, those whose mothers experienced famine early in the pregnancies were more likely to be obese and have diabetes. The stage of pregnancy was found to be important: Although those whose mothers were in middle to late pregnancy during famine were born lighter than most babies, as adults they were at no greater risk of obesity.

The theory is that the genetics of babies affected early in prognancy were programmed for a world of famine, but born to plenty, and perhaps the children's metabolism predisposed them to gain weight. This theory was given greater weight with new research published in 2010 by Leiden (Netherlands) and Columbia (New York) universities, which found those specific children of the Hunger Winter carried a different setting on a gene that controls growth.

Other research suggests that babies born to mothers in the United Kingdom who were eating a low-carbohydrate diet were more likely to become obese.

 

How does all of this feed into what we're seeing in Canada?

Dean's own research is looking at how a mother's health influences that of her fetus, particularly mothers who have Type 2 diabetes.

Metabolic functioning develops in the first trimester, she points out. That leads some to wonder if a mother's diet at that time can affect a child's ability to process food -- fuel -- into energy, or whether it gets stored as fat.

With the rising incidence of obesity and diabetes among teens and young adults, the question falls to the potential impact on a fetus. Type 2 diabetes develops when the body cannot keep up with the production of insulin required. Insulin, secreted by the pancreas, is required to process glucose (carbohydrates) and fat. When that process breaks down, sugar doesn't get metabolized as energy, but gets stored as fat.

Does this condition in pregnancy affect the fetus's developing pancreas?

"Maternal obesity in pregnancy used to be rare compared to what we have now. Therefore there is a different environment in which a fetus is growing, a different metabolic environment in which a fetus is developing," Dean says.

This has urgency as new generations of children increasingly develop obesity and diabetes. The trend may be exponential, Dean points out.

Once thought to be strongly associated with genetics or simply bad eating habits, obesity now is recognized as a much thornier problem, influenced by an intricate interplay of nature and nurture.

That fact is discouraging, in one sense. But it also means that science may help, too.

 

So what can we do?

Most of us can control our weight, but it's tough, since it is involved with our relationship with food, which is cultural, economic and emotional.

Being careful with what we eat and how we feed our babies and toddlers is vital, of course. Role-modelling is an important teacher and developing the baby's palate for healthful foods will serve him well as he matures and eventually sets his own table.

Exercise is vital as well. Lives are hectic and exercise routines demand so much of a person's day, especially for parents whose children have their own crazy-making schedules.

But walking, the plain old, doable promenade -- to school, to work, to the neighbourhood grocery mart or a community centre -- is a very good way to get moving and stay fit. The problem, of course, is that it is time-consuming.

Golondrina's day is illustrative. Some days she is at school by 8:30 a.m. Red River College is too far to walk. She is on community work placement at a school now, so those days start early and end closer to suppertime.

Rhys and Keagan have to be picked up at daycare and then they rush home for supper and all the other must-dos -- Golondrina also runs a tattooing side business. On social assistance, she is allowed to keep the first $200 she makes in any month and a percentage after that. It's a good lesson for the kids in self-sufficiency, and it paid for the new table and chairs.

She has her teens prepare supper during the week and Rhys likes baking, making muffins from an instant mix. Exposing children to the nuts and bolts of nutrition, she hopes, arms them with knowledge for when they buy their own food.

 

How do the messages parents signal affect food attitudes?

McGavock says how kids eat is important, and that is ingrained very early.

He says it has been shown that young children naturally self-regulate the amount of food they need according to energy expenditure.

The young are natural grazers.

So don't admonish your children to "finish your plate" -- a toughie for those of us who grew up with not much and thankful for every mouthful -- because if they've stopped, they're full. Forcing them to finish their plates is teaching them to eat more than they need. Not a good life lesson.

And neither is it healthy for your children to see you skip meals.

"I do not believe my eating habits are good examples for my children," says Golondrina.

Her life and that of her kids has been chaotic, with lots of crises that made coping difficult.

"My kids have a lot of security issues," she says. That has translated into different behaviours in her children.

"Keagan finds comfort in food. He eats because he's bored, because it's there, because he's hungry."

It is tough for parents, especially those juggling a number of issues at home, to regulate their children's eating habits, particularly with kids battling weight problems.

A person's relationship with food, their weight and their body image are so tied to self-esteem that how you deliver the message is critical.

Dietitian Watson Jarvis says the eating habits of very young children are set by parents, influenced strongly by what food is in the house and the family's mealtime routine. The more of the wrong stuff -- chips, pop, other ubiquitous, high-cal snacks -- the harder it is to control weight.

But, she says, intervening on an adolescent or a teen's eating habits is a delicate proposition. Maybe your child eats because they are growing and constantly hungry.

Don't try to stop the eating, which can be a negative message with broad effect. Stock lots of fruits and vegetables in the house so they are the go-to snacks, she advises.

Same goes for adults who are compulsive eaters -- keep the carrot sticks close at hand.

Teaching kids about an adequate portion of food on their plate also helps them understand appetite and allows them to go back for more if they still feel hungry. Teach your kids to read labels and nutrition panels.

There are other elements of how our bodies bulk up, too.

For example, McGavock points out that research shows those who sleep less or have interrupted sleep patterns have lower levels of the hormone leptin, which suppresses appetite.

So maybe the young teen who is up at night after Mom and Dad head to bed is constantly in the refrigerator because the teen is sleep-deprived, not because of hunger.

 

Why don't we just stop eating so much? Problem solved, right?

No. That's a big, fat no. Drastically reducing calorie intake, unless it's done with the advice of a doctor, sets you up for disappointment.

People who go on crash diets do themselves no favours.

James Friel says the body is a wily operator. If you drop the amount of energy available to your body, your metabolism will slow down.

Self-preservation is biologically primal, as it turns out.

So if you start eating a normal 2,000-calorie-a-day diet again, you will gain weight.

Friel, a U of M professor in human nutritional sciences, says the best approach is to make small, lasting changes to your lifestyle. That means, for example, cutting out treats to reduce 100 or so calories daily. Pair that with walking 15 minutes or so a day.

The combination of a little more exercise and a little less food every day will be easier to maintain and will pay off over the long term, which is how a healthy weight is achieved.

The wrong approach, for most of us, aims for speedy weight loss and that is counterproductive and ultimately discouraging.

 

The grocery store lesson: the economics of eating

Golondrina does the math: She checks the bank account. The child tax benefit cheque of $1,100 has come in, which means this will be the once-a-month "big shop." And good thing, too, because they're running out of staples and stuff like toilet paper and laundry detergent.

"I hate shopping," Golondrina says.

She finds a sitter for the younger boys and is accompanied by one of her teens, who keeps track of the tab as they go along. Inclined to impulse buying, she needs help to stay on track.

"I don't want to be embarrassed at the checkout," she says.

Patricia, 16, uses her phone's calculator. Giant Tiger is busy -- specials galore, as though the retailer knows when those government cheques are posted.

A lot of Gilbert Park neighbours are here, so shopping takes on a social feel.

After checking out the deals on clothing (pants marked down to $5), Golondrina and Patricia move to the food aisles. Steal of a deal: rye bread, four loaves for $5, and bacon, two packs for $5, limit six per customer.

At stage one of their shopping, they grab another cart.

To get to the produce section, and then the meat coolers, they have to navigate through the shelves of candy, treats, nuts and the aisles of toilet paper, detergents and other household necessities.

Golondrina gets to the fruit section and stops as Patricia shows her the total: "$130 already."

Golondrina pushes on, picks up cartons of nectarines, bags of apples and fresh vegetables, moves to meats: a tray of nine pork chops is $6. How is that possible?

Now she tallies again: $166. Patricia gives her mom a gentle financial nudge. "You say we're paying daycare at the end of the month?"

Creamed corn, 75 cents a can, popcorn snack balls, flour, two cases of Mr. Noodle, 50 cents for Mr. Pasta mac and cheese, rotini pasta at a dollar a bag. The lasagna, the cheese that can't speak its name, frozen pizzas, a four-litre jug of milk, frozen chicken breasts and flavoured meatballs.

The cart fills and stress mounts.

She and Patricia unload at the cash, their faces focused on the register.

"I got an $800 bill for daycare for one month this summer because the subsidy didn't go through," says Golondrina. She is thinking about the paperwork that will have to be done to settle that bill. She has bill collectors calling her from old debts. Nine years ago Revenue Canada came after her for unpaid income tax from when she was working the two part-time jobs, so for the past eight years she has not received a tax refund.

Keagan has been on her again about signing up for football at the community centre. Patricia, who asked if there's room in the budget for furniture -- the Golondrinas have had to throw out furniture twice due to bedbugs, a fact of life in subsidized housing units -- puts back the white socks, the earbuds and the triple-frying pan, $9.97 deal, as the register tape lengthens.

"This causes too much stress," Golondrina mutters, smoothing her hair back from her brow. Again.

It's $394, and the eggs and nectarines have yet to sweep past the scanner.

Golondrina asks the checkout clerk to take $400 from her bank card, and then counts out another $53.23 cash.

Momma must be off her game today, she says.

"I'm so tired of the catch-up."

The frozen pizzas will go into the oven tonight, because Momma, exhausted with work yet to do, can't bear the thought of cooking.

 

What to do, especially for those who can't afford to eat healthy?

All Canadians are facing the rising cost of food, but none more so than the working poor and those on social assistance.

Golondrina is hard-pressed to absorb the hit when the grocery tab gives her less for more.

She tries to make homemade soups, a time-consuming meal to prepare. The little produce she gets from community gardens each fall helps for a while.

She says food must get cheaper somehow, or people won't stop buying the high-salt, high-fat, high-calorie fare.

How to do that, she can't say.

But one thing she is adamant about is hiking welfare rates is NOT the answer.

"If you increase social assistance, it makes it harder to get off welfare and then you would have to raise the minimum wage."

Golondrina has worked out how much she would have to earn to replace all the income she gets while on social assistance (including subsidized housing and day care).

"I need to make $20 an hour to live the way I'm living now and support my children."

But she sees getting off social assistance is critical to her family's welfare, to showing her children being self-sufficient is a better way of life. That's why they are involved in helping her balance the budget.

She gives them allowance so they can learn to manage money -- Rhys and Keagan figure out how to pool their cash to buy a Lego set -- and to keep them from desperately wanting things others have.

She says her children are amazing people, brilliant in their own right. Patricia is strong in math and physical education and is thinking of being a teacher; an adviser at the local resource centre told her to become a city police officer, because she can retire early and start a second career.

For her own future, Golondrina is trying to lose some weight, assiduously taking the stairs at school, where she is learning the skills to help community groups thrive.

She wants to get into politics someday, to add a perspective she sees too frequently missing from policy debates.

Few of those who set public policy have lived the realities of raising children on the narrowest of margins, economically and socially.

Today, she hears some physicians want the state to seize children who are persistently obese.

"They take kids away because they're overweight?"

Yes, in the U.S. it has happened, and apparently, it worked in one case. In another, well-publicized case, a Washington teenager kept running away from home, and social workers, acting on orders and sometimes accompanied by police, repeatedly intervened but with flagging enthusiasm.

It suggests there are myriad forms of child abuse and last resorts should be just that. Some believe as a nation and a village, Canada has a lot to learn about the nuances involved in managing weight, health, disease and diet.

That concept of community is at the root of interventions Dean and Watson Jarvis see as more hopeful: First, education, education, education, then neighbourhood cooking classes, bulk buying, community gardens and co-operative child-minding.

"It's almost scary to think your children can be apprehended because you're feeding them too much," Golondrina says.

catherine.mitchell@freepress.mb.ca

Republished from the Winnipeg Free Press print edition January 21, 2012 ??65535