Parents’ knowledge of the 2019 Canada’s Food Guide recommendations

As part of Canada’s Healthy Eating Strategy, Health Canada released a revised Canada’s Food Guide (2019 CFG) in January 2019 (Health Canada 2019). Compared to the previous 2007 CFG, the 2019 CFG underwent several changes, including the amalgamation of the Meat and Alternatives and Milk and Alternatives food groups to a single Protein Foods food group, the replacement of the rainbow format with a plate model to depict the three food groups (Vegetables and Fruit, Whole Grain Foods, and Protein Foods), and the addition of recommendations for healthy eating habits in recognition of the influence social, cultural, and environmental factors have on Canadians’ food choices (Health Canada 2019).

Canadian adults’ awareness, use, and opinions of the 2019 CFG have been explored using surveys (Charlebois et al. 2021; Ramuscak et al. 2022), focus groups (Leme et al. 2022; Laila et al. 2023), and social media analysis (Woodruff et al. 2021). Overall, these studies have found high awareness of the 2019 CFG recommendations and mostly positive opinions. Specifically, research suggests that most Canadians agree that the 2019 CFG is a helpful and trustworthy resource, is based on scientific evidence and best practices, and is flexible to meet their dietary preferences (Charlebois et al. 2021; Ramuscak et al. 2022). However, some research has also revealed negative perceptions of the 2019 CFG, including concerns regarding the perceived omission of dairy products, insufficient guidance on plant-based proteins, and the affordability of meeting the 2019 CFG recommendations (Charlebois et al. 2021; Woodruff et al. 2021; Leme et al. 2022; Ramuscak et al. 2022; Laila et al. 2023).

Less research has explored Canadian adults’ knowledge of the 2019 CFG recommendations. Intervention research suggests that, while certainly not the only factor needed for behaviour change, nutrition knowledge is an important determinant to facilitating diet behaviour change (Patterson et al. 1996; Petrovici and Ritson 2006; Dammann and Smith 2011; Rustad and Smith 2013; Sponk et al. 2014). Thus, understanding Canadians’ knowledge of the 2019 CFG may help inform knowledge mobilization and intervention approaches to support adherence to the 2019 CFG recommendations. The objective of this brief communication is to explore parents’ knowledge of the 2019 CFG recommendations. Our team previously compared parents’ awareness, knowledge, and opinions of the 2007 and 2019 CFGs across factors of relevance to both Food Guides (Ramuscak et al. 2022). This paper describes parents’ knowledge specific to the 2019 CFG that was not included in the previous analyses.

Sociodemographic characteristics of the 122 parents who responded to the 2019 CFG knowledge questions are presented in Table 1.

In response to the item “Please list the main recommendations from the new CFG”, parents referred to the plate proportions (38%) with most parents referencing the recommendations to make half their plate vegetables and fruit. Specifically, 14% of parents spoke to the recommendations to make half their plate vegetables and fruit, while 7% of parents commented to make a quarter of their plate whole grains and 6% commented that a quarter of their plate should be protein foods. Other recommendations listed by parents were to eat more plant-based proteins and less animal proteins (34%) and to make water their drink of choice (22%). Less common recommendations listed by parents included to limit consumption of foods high in sodium, sugar, and unhealthy fats (15%) and recommendations related to healthy eating habits, including to be mindful of your eating habits, cook more often, eat meals with others (13%), use food labels (4%), and be aware that food marketing can influence food choices (3%).

Less than one-third (27%) of parents correctly listed all three CFG food groups (Vegetables and Fruit, Whole Grain Foods, and Protein Foods). Common incorrect answers included parents not identifying “whole grains” and using terms such as “grains”, “grain products”, “carbs”, or “starches” (37%), only listing one correct food group (18%), stating “can’t recall” or “don’t remember” (8%), or naming 2007 CFG food groups, such as Milk and Alternatives or Meat and Alternatives (5%).

About 19% of parents correctly identified that fatty meats, high-fat dairy products, highly processed foods, and some tropical oils are all foods that contain unhealthy fats (saturated or trans fats) according to the 2019 CFG recommendations. While 77% of parents correctly identified highly processed foods as a food containing unhealthy fat, only 29% of parents identified some tropical oils as a food containing unhealthy fat according to the 2019 CFG recommendations.

Nearly all parents (98%) correctly identified that the new CFG recommends Canadians should cook more often.

In a sample of 122 parents, we found relatively high levels of knowledge of the 2019 CFG’s healthy eating recommendations, such as eat more plant-based proteins and make water the drink of choice, but lower levels of knowledge of the specific details of the recommendations, such as the name of all three food groups and which foods contain unhealthy fats. These results suggest that additional communication may be needed to support Canadians knowledge of dietary recommendations.

Only 27% of parents correctly identified all three food groups in the 2019 CFG: Vegetables and Fruit, Whole Grain Foods, and Protein Foods. Common incorrect answers included parents not identifying “whole grain” foods as a food group and using terms such as “grains”, “grain products”, “carbs”, or “starches” (37%). This finding is similar to Vanderlee and colleagues (2015) study on the 2007 CFG where only 43% of participants were able to correctly recall all four food groups, with the Grain Products food group being the least commonly recalled. Of the many changes to the 2019 Food Guide from the 2007 Food Guide, one of the most significant changes was the emphasis of “Whole Grains” from Grain Products (Health Canada 2019). Whole grains contribute key nutrients to one’s diet, such as dietary fibre, protein, vitamin B6, and magnesium, and high consumption has been associated with a reduced risk of developing noncommunicable diseases, such as cardiovascular diseases, cancers, gastrointestinal disorders, and type 2 diabetes (Prasadi and Joye 2020). However, national data suggest that many Canadians are not consuming whole grain products, with 70% of Canadians failing to make half of their grain products whole grain (Hosseini et al. 2019). Given the consistent finding that the Whole Grain Foods food group is poorly recalled, and Canadians are failing to consume adequate amounts of whole grains, it is important that knowledge translation efforts be put toward educating Canadians on what differentiates a whole grain food from refined grain food and supports to increase availability and consumption of whole grain foods.

Parents also displayed poor knowledge of CFG recommendation on foods containing unhealthy fats, with only 19% of parents correctly identifying fatty meats, high-fat dairy products, highly processed foods, and some tropical oils as foods containing unhealthy fats. While 77% of parents were able to correctly identify highly processed foods as an example of unhealthy fats, only 29% of parents were able to identify some tropical oils as foods containing unhealthy fats. Over the past 10 years, consumption of tropical oils, specifically coconut oil, has risen in popularity among the general population due to effective marketing strategies of their purported health benefits of weight loss, improved immunity, heart health, and enhanced cognition (Sankararaman and Sferra 2018; Duarte et al. 2022). Despite the growing body of literature indicating an absence of cardiometabolic benefits from the intake of coconut oil, individuals continue to believe coconut oil to be a healthful food, with Duarte and colleagues (Duarte et al. 2022) reporting that 82.5% of participants in their study considered coconut oil to be healthy. Given the complexity of the research around saturated fatty acids and misinformation on the healthfulness of tropical oils, it is important that Health Canada continues to monitor the growing body of literature to create clear recommendations for the general population that are easy to understand and implement.

When asked to identify the main 2019 CFG recommendations, more parents identified 2019 CFG recommendations related to food choices such as plate proportions, while fewer parents identified 2019 CFG recommendations related to healthy eating habits (e.g., to be mindful of food choices, eat with others, and cook more often). This finding suggests that food choice recommendations, which have traditionally been the focus of previous CFGs, may resonate more with Canadians than the newly added healthy eating habits recommendations. Conversely, when parents were asked “The new Food Guide recommends that Canadians should cook more often. True or False” nearly all parents (98%) correctly identified that the 2019 CFG recommends Canadians to “Cook more often”. High level of knowledge regarding this specific recommendation may be due to the way the question was asked, as a dichotomous true/false question. However, in line with previous qualitative research, Laila and colleagues (Laila et al. 2023) identified that parents were aware of the 2019 CFG healthy eating habits recommendation and perceived their addition to CFG as beneficial to supporting an overall positive relationship with food. Future research should expand the current findings by examining Canadians’ knowledge of all 2019 CFG recommendations, including those focused on healthy eating habits.

Our study adds to the growing body of literature on the knowledge of 2019 CFG through the unique perspective of parents; however, it is not without limitations. Firstly, our study sample is mainly comprised of a homogenous group of White (84%), highly educated (71% university graduates) parents from high household incomes (69%, ≥$100 000) who reside in Southwestern Ontario. Thus, the results of this study may not be generalizable to Canadian parents from ethnically diverse or low-income backgrounds or those from other geographic regions on Canada. Future research should examine the relationship between Canadians’ knowledge of 2019 CFG recommendations from a diverse sociodemographic and geographic sample. Secondly, our survey did not ask parents about their specific knowledge on all CFG recommendations, such as the use of food labels or the influence of food marketing on food choices. Future research should examine Canadians’ knowledge of all 2019 CFG recommendations and whether this knowledge is associated with improved healthy eating habits. Lastly, parents were provided survey questions about the 2019 CFG from March 2019 to March 2020. Thus, it is unknown whether longer exposure to the 2019 CFG past March 2020 is associated with increased knowledge of the 2019 CFG recommendations. Future prospective research is needed to examine how longer exposure to the CFG and additional knowledge mobilization about the CFG by Health Canada impacts parents’ knowledge of the CFG 2019 recommendations.

In conclusion, our study found that parents had a general understanding of 2019 CFG recommendations; however, the majority of parents had poor knowledge of CFG’s food groups and unhealthy fats. These findings can be used to help improve future CFG revisions and knowledge translation strategies by curating evidence-based, easy-to-understand recommendations and implementing education programs to address Canadian adults’ knowledge gaps and improve their understanding of healthy eating guidelines.