Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue 25 - Evidence - January 29, 2015
OTTAWA, Thursday, January 29, 2015
The Standing Senate Committee on Social Affairs, Science and Technology met this day at 10:27 a.m. to examine and report on the increasing incidence of obesity in Canada: causes, consequences and the way forward.
Senator Kelvin Kenneth Ogilvie (Chair) in the chair.
[Translation]
The Chair: Welcome to the Standing Senate Committee on Social Affairs, Science and Technology.
[English]
I'm Kelvin Ogilvie from Nova Scotia, chair of the committee, and I'm going to invite my colleagues to introduce themselves.
Senator Seidman: Judith Seidman from Montreal, Quebec.
Senator Nancy Ruth: Nancy Ruth from Toronto.
[Translation]
Senator Chaput: Maria Chaput, from Manitoba.
[English]
Senator Eggleton: Art Eggleton, senator from Toronto and deputy chair of the committee.
The Chair: Thank you, colleagues. We welcome our guests this morning. I will identify them when I ask them to speak.
Before I do that, I will remind us all that today is our third meeting on a study to examine and report on the increasing incidence of obesity in Canada, causes, consequences and the way forward.
I'm very pleased with the witnesses that we have presenting to us this morning. It should be an informative meeting. They have agreed that I can call them in the order that they were listed on our agenda. That simplifies things considerably. In that regard, I will begin with Dr. Angelo Tremblay, Advisory Committee Member to the Canadian Nutrition Society.
[Translation]
Angelo Tremblay, Advisory Committee Member, Canadian Nutrition Society: Mr. Chair, thank you for the opportunity to appear before the committee.
[English]
My colleagues from the Canadian Nutrition Society and I greatly appreciate the opportunity that has been given to our society to talk about the important issue of obesity.
Our society is a research association. Our main mandate is innovation in nutrition, so we try to develop new concepts. We also wish to contribute to nutrition education, advocacy, and we also have the responsibility to continue to contribute in the training of experts of the future generation.
In this short presentation I will emphasize seven points. The first one would have "leadership'' as its key word. We wish to communicate our appreciation to the federal government and related agencies, like Health Canada, for nutrition guidelines. We encourage this dissemination. Furthermore, we insist on the importance of literacy because it is important to provide Canadians with tools and skills to understand and to use what is provided in terms of guidelines.
With respect to the government engagement, it is also important to emphasize the issue of advertisement of new products, of healthy eating. Of course, we encourage strategies favouring the dissemination of healthy eating. We would certainly appreciate legislation restricting the dissemination of unhealthy claims and of claims promoting confusion, which are so frequently used in the field of obesity.
The second point is related to partnership. At the Canadian Nutrition Society we strongly believe that it is our role to help the agri-food industry to improve the offer of healthy foods, to offer new services. It is part of our tradition to nurture good collaborations with the agri-food industry. We take advantage of this opportunity in the context of our annual meetings, be it the workshop that we organize every year, but also our annual meeting, which is a platform giving the opportunity to talk about new ideas, develop new concepts and to share collaborative efforts with the private sector to ultimately bring consumers the good products and services that are emerging from our scientific activities.
The third point is supporting research. We are convinced that to progress, it is important to better understand in order to better intervene. In Canada, we have very competitive research centres that contribute to the visibility of Canada all around the world, and they need the funding support of Canadian agencies to maintain their competitiveness and to continue to develop new concepts that will ultimately benefit all Canadians.
The fourth point is related to the link between obesity and the socio-economic status of people. There is a link between the proneness to obesity, diabetes and other related diseases and the socio-economic status of Canadians. More specifically, underprivileged people are more susceptible to display problems. Clearly, for governmental agencies there is a common consideration between the fight against poverty and the intervention aimed at the prevention and management of obesity.
The fifth point is that obesity is more complex than what is generally considered. We focus a lot on healthy eating and active lifestyle, and it is not wrong. It is totally appropriate, but it is important to emphasize that there are other factors related to our lifestyle. Among them, one of the most recently documented is short sleep duration. It contributes to altered appetite control, which is associated with being overweight, and that is partly deteriorated by the use of computerized devices. You may have children or grandchildren sleeping with their iPhones ringing and disturbing sleep habits. One recommendation is to consider the globality of determinants involved in obesity.
Very briefly, the sixth point is a link with environmental considerations. It is an issue for Canada. Emerging data suggests a link between chemical pollution and maybe even atmospheric CO2, appetite control and the proneness to overweight. So our global lifestyle may be more linked to obesity compared to what we were traditionally inclined to believe.
I will conclude by insisting on the emergency to do something. This belief is mostly based on a federal report published in 2012, the Canadian Index of Wellbeing, providing good news about life expectancy. For instance, between 1994 and 2010 we gained a mean of 3.7 years of life expectancy; but during the same period, life expectancy adjusted for health was decreasing by almost four years. This is certainly not what we wish to reach. We do not wish to add years to life with pain and suffering. We wish to add years with well-being, health and happiness. These federal statistics tell us that even if the preoccupations that we are talking about today are moving slowly, there are indications that the time has come to do something very significant.
Thank you very much for the invitation and the opportunity that has been given to our society. It is considered as an appreciation of confidence and recognition of our expertise.
The Chair: Thank you, doctor.
I'll now turn to Pat Vanderkooy, Manager, Public Affairs, Dietitians of Canada, please.
Pat Vanderkooy, Manager, Public Affairs, Dietitians of Canada: Good morning, all. I'm Pat Vanderkooy, a long- time dietitian. I work with Dietitians of Canada and represent many people with whom I've worked. Thank you for inviting us.
I'm shortening the notes a little from what you have in front of you.
We are the professional association for dietitians, about 6,000 members across Canada. Registered dietitians are regulated health professionals. We work in health care, public health, as well as academia and the food industry. In October, you already emphasized many important points: a health lens in all policy, simple educational messages, government leadership and policy to support comprehensive change, monitoring and evaluation to stay the course.
There are many factors, which Angelo has spoken to, and not one strategy will reduce the risk for all: over- consumption of food products, especially the less healthy food choices; children consuming about a quarter of their calories from sugar and processed snack foods, adding the equivalent of a fourth daily meal; and eating out more often, but it's not easy to eat healthy when menus provide no calorie or nutrition information, serving sizes are huge, healthy choices cost more, and unhealthy choices are more heavily promoted.
Fewer meals are eaten at home together as a family, and yet the benefits of family meals include healthier meals and lower risk for overweight children.
Many Canadian children and adults have limited skills in choosing and preparing healthy foods. We have powerful food and beverage advertising that is directed particularly toward children. Food companies invest billions of dollars in advertising. Many advertised foods are not the healthiest choices, yet health education campaigns can't compete.
One in eight Canadian households is food insecure primarily as a result of poverty. Food insecurity adversely affects health and children's learning and development. This has been referred to. Cheaper foods tend to be higher in calories, sugar, fat and less nutritious. In 2010, Curbing Childhood Obesity, the government report I'm sure you're familiar with, referred to a "national crisis'' and called for a "sustained multi-sectoral national response.'' These recommendations are relevant today: make childhood obesity a collective priority amongst government and other sectors and coordinate the efforts; supportive environments for healthy eating; early action for kids at risk; increased access to nutritious foods; and decreased marketing directed to children; and measure and report on the collective process and adjust as appropriate.
Health Canada's Office of Nutrition Policy and Promotion has already done a fine job publishing much evidence, which you have in the end notes of your document. It's time for collective pan-Canadian actions. We're doing much of this already in different areas. We're working through education, community interventions and advocating for policy, but we haven't got it all together yet. The following are some examples of what is happening.
We have healthy food and nutrition policies in schools and child care facilities across the country. We have the Provincial and Territorial Guidance Document for the Development of Nutrient Criteria for Foods and Beverages in Schools — really good progress by a provincial-territorial group that put together these criteria. However, not all provinces and territories have harmonized with those criteria yet. Meanwhile, the food industry would like to see one set of criteria so they know where they're going. When we have it harmonized, we could drive healthy reformulation in the food supply because the food industry would know what we're asking for across all the schools in Canada.
Restrict advertising to children. Four years ago, Dietitians of Canada called for federal government leadership in setting standards to control advertising directed to children, and there's been no progress. We conclude that food industry self-regulation isn't working. Again, coordinated government-supported action is needed. We promote healthy food environments and all that that includes, and we can talk more about that.
We call on your support and commitment to a broad, comprehensive strategy to pull it together. We need your leadership. At a very high level, we need a national food strategy, one that brings in the economic, the agri-food, and health factors. I'd like to say that health should be the driver of the food supply. It should be a primary factor, but there are many.
We need to pay special attention to food system challenges affecting vulnerable communities and Aboriginal peoples.
We need a national poverty reduction strategy because some households can't pay for housing and food. and we know that food insecurity leads to greater risk of developing chronic health problems. It makes sense to invest in these households now.
We need monitoring and surveillance. We had the Nutrition Canada National Survey in the 1970s and the Canadian Community Health Survey in 2004. For the years between those dates, we don't have national data, and yet that's precisely when our food system, physical activity patterns and the general landscape were changing. Fortunately, this year CCHS is collecting data again, which is fabulous, and we'd like that consistent commitment.
Thank you very much for listening and hearing what we have to say. We're doing well. We just need to get it together. We ask for leadership and support from the federal government to help us along the way.
The Chair: Thank you very much.
I will now turn to Dr. Vladimir Vuksan, who is appearing as an individual.
Dr. Vuksan, please make your presentation.
Vladimir Vuksan, Professor, Department of Nutritional Sciences and Medicine, University of Toronto, as an individual: Thank you very much. I'll refer to some slides that I sent around, so you can kindly follow me.
I'm certainly honoured to be here today and to have this opportunity to talk about problems such as obesity, which is one of the main health problems in Canada and elsewhere in the developed world. I'll be talking about that and pointing out some controversies. I'll try to give some solutions and, if you would allow me, some recommendations.
I want to show you something that I brought. I was fortunate that I was able to pass through security here at the door because what I have is actually a weapon of mass destruction; but don't be scared, although we all should be scared. It's in a little Loblaws bag — too good to be true. This is an artifact of human fat — about three kilos. At the Toronto airport, they stopped me and said, "What do you have?'' I didn't know what to say as it's kind of unusual, so I said, "This is like my fat. Sometimes I carry it inside and sometimes outside.'' They let me through as they thought it was funny.
I want to start with a simple example on the next slide. I will give you a case where one has ten kilos of extra fat in weight. This is just to move body mass index three units, so that's not much. If you are normal weight and add ten kilos, you will be just entering the obesity range. In this case, one has ten kilos. If you ask a pathologist, he will say that each kilogram of human fat requires 6,000 metres or 6 kilometres of arteries to perfuse. It's simple math as you multiply by ten; so ten by six kilometres is 60 kilometres. The heart has to pump an additional 60 kilometres every minute, which is 72 times. I calculate that this is like going five times from Ottawa to Toronto, which I was doing yesterday on the plane. It all depends on the warranty given by the parents' genetics as to how long this heart will be able to perform.
On the next slide is my outline. I will talk about the problems, solutions, pointing out controversies and a call for action.
The health consequences are numerous. I mentioned some already. I put in the main category mental — depression, anxiety, self-esteem; mechanical — osteoarthritis; and metabolic — diabetes and hypertension, which I do a lot of work with at my clinic in Toronto.
On the next slide we talk about incidence and prevalence of diabetes. We have both on the same slide. According to the Canadian Medical Association Journal, obesity in Canada increased 200 times in 26 years, from 1985 — so actually triple. Then, in the same article, they predict that by 2019 there will be 16 per cent more obese. There were no territories included in this calculation.
Just three days ago, we received Canadian guidelines for prevention of weight gain, and they refer to 2011 — 26 per cent of people being obese. That's a higher category than overweight.
We recognize, and it was mentioned before, that children are also at risk in Canada. In 2013, 12 per cent of children were obese and 19 per cent were overweight. If nothing is changed, and I use conservative statistics that I showed in the previous slide, for children born in 2010, 50 per cent of them will become obese in life if you don't do anything, an increase from 12 to 50. That's a big, big change. So something must be done, as pointed out already.
The next slide shows causes and traditional solutions, which are basically the same. What we have to do — this is called "the big two'' — is eat less and move more. We discussed non-traditional causes of obesity, problems with sleep and other manmade environments, obesogenic environment, et cetera. We know we don't have a very good program in Canada for looking after weight, and obesity is increasing.
There are also widely held misconceptions about obesity. As Dr. Tremblay mentioned, we don't do enough research to understand the problem, and this could lead to poorly informed clinical decisions, inaccurate public health recommendations, unproductive allocation of limited research resources, and programs will fail and obesity will continue to grow.
Then I mention some myths, presumptions and facts about obesity in the appendix. I will briefly talk about some facts, and then I'll make a conclusion.
Obesity is always being discussed, but it seems to be clear that genes are important. We are vulnerable human beings, some say, because of our genes. We are prone to develop obesity. We have the opportunity for this in a given environment. But the environment seems to be more important, because in the last 30 years, as we have doubled or tripled obesity, we basically didn't change genes. That's important.
Low-energy diets cause weight loss. I think we can achieve this in some of the programs, but to sustain and stay this way for a longer period of time is very hard.
In terms of the tools for the general public, we should encourage exercise. Now we are talking more and more about exercise that will not only reduce weight but increase health, so that's actually the key. Exercise and physical activity should be substantial, and not mere participation. There is a good example in Canadian schools, where children do exercise, but that's not enough. Now they are finding that children have to go home and continue exercising with their parents and talking about diet and nutrition.
If we decide to do this ourselves, and as a population, we have to learn that it is a lifetime crusade; we have to really look at what we are doing and what we are eating.
In the clinical setting, there are some success stories regarding meal replacement that could be useful. Some of the drugs might be useful with a low-energy diet, but they could be dangerous and have side effects. Bariatric surgery is more and more popular. Unfortunately, we have started developing in Canada not only obesity but level 3 obesity, which is actually elephant obesity, which requires surgery.
The take-home message is that we need to develop a national program formulated on clinical research recommendations and sustainable public health policies. I had a dream that we in Canada can reduce body weight by 5 per cent in five to ten years. That's probably possible — at least, I have a dream — and start reversing the obesity epidemic by 2030.
How to do this? Programs should be rooted in scientific evidence, and we probably have to do more research to understand. Being economically viable to be able to pay this, supported and promoted by the federal and provincial government, is key, and industry as well.
Concretely, I suggest we can do this by borrowing a concept from the United States, the "enhanced small-changes approach,'' and hence maybe cut a little on diet and maybe a little more walking — that could be a winner — and expansion of current knowledge and more research in this area.
Thank you very much.
The Chair: Thank you all.
Senator Eggleton: Thank you for your interesting presentations and perspectives on this question of obesity. Obesity has been always with us, I guess, and genetic reasons have always been there. What one eats and how much one exercises has been talked about for years and years and decades and decades. But in the last few years, in the last few decades, the situation seems to be getting an awful lot worse, particularly for our children. What is happening of late that's causing this problem, this increase in obesity?
Ms. Vanderkooy: A shift has happened. Our food environment is filled with more food that is more energy dense, and it's being marketed everywhere. We didn't used to have vending machines and places where we could quickly pick something up. Now we walk in a distracting environment. Kids used to play and there was no distraction. They knew the rules: You didn't go into the fridge between meals; you just went out and played.
So that combination of being distracted by many things in the food environment, not playing as much, in front of the screen, where, unfortunately, you're prone to the marketing that's quite aggressive, which is directed to children, which we believe is unethical because of their developmental understandings; and then, as was mentioned, sleep, the rush-rush, not eating meals together. These things sound motherhood, nanny state, whatever you want to call them, but they're very real social changes that come along with mental health repercussions, that come along with levels of stress, and that brings out the propensity toward gaining weight.
So it's little bits and pieces that have all come together. In some ways the gain of weight is like the tip of the iceberg; it's the physical sign that a lot under the surface has contributed.
Mr. Tremblay: Another thing that has happened is computerization. In the 1980s it happened. I refer to an American study that was performed between the beginning of the 1980s and the end of the 1990s documenting the change in the profile of activities of young kids and adolescents: sports not having changed so much; TV viewing as having decreased a little bit; and school-related homework and computer use substantially increasing.
Now we have an indication that demanding mental work increases energy intake without changing energy expenditure, and it may disturb the quality and duration of sleep. Very recently we got the approval of a paper with conclusions that are discouraging, since kids, young boys performing a lot of school-related homework that is perceived as stressful, have a more pronounced adiposity.
The profile of human activity has changed. In this context, we are in conflict with ourselves, because clearly we will not spontaneously reverse computerization. It is bringing something new that is not facilitating body weight stability.
Mr. Vuksan: That is an excellent question, the $64,000 question. Let's try to answer for the first $30,000.
I think the nature of humans is that we are not adapted to this obesogenic environment. We are surprised by this; we are shocked. The industry has had incredible development in terms of manufacturing refined food. They did this wonderful job. Our palate likes this food and we are prone to this. We eat more and exercise less. We have this "thrifty'' gene where we historically don't want to move unless we go to hunt. Between hunting we lay down and save energy. That's in our genes, and we cannot cope with this environment around us.
If you go anywhere in Canada, there are escalators. I'm probably only one of the few people who walk on the stairs next to the escalators in Toronto. You don't know where you will come out if you walk up any stairs or if the door is open or not. There is a problem.
I work on the island of Malta, in the middle of the Mediterranean Sea, and everybody swears this is the best diet ever. What is the Mediterranean diet? It was when Sicily was poor in 1950, so there was not much food. There was not enough rain and the land was difficult. We don't have this work, and we have this wonderful food. Overall, the Mediterranean diet is not what it used to be. You can't cope with too much olive oil, which is being pushed at us.
We have to look at more traditional food. If you like a low glycemic index, we look at some foods that are traditionally processed. That's in addition to the wonderful discussion of my colleagues.
Senator Eggleton: I think the Mediterranean diet is terrific, but I'm going to zero in on a question that you've all covered.
Dr. Tremblay, you talked about the need for publications and eating guidelines to better enable nutritional literacy. On the other hand, we also heard from Ms. Vanderkooy that the powerful food and beverage industry directs its billions of dollars of advertising and its choices, which may not be healthy choices, at children. That's pretty formidable to take on.
There have been some discussions in the past about restrictions with respect to advertising. I think Quebec has some restrictions on advertising, but broadcasting nationally is a federal responsibility.
I'll ask all of you this: Should advertising directed at children on television be banned?
Mr. Tremblay: You are right. In Quebec we have legislation restricting advertising to children. It seems to contradict the freedom that we seek in our everyday transactions, but ultimately this may be the only way to proceed.
Having the experience to witness misleading claims in court by promoters who do not have good ethics, you conclude that this is maybe one way to explore, to at least a priori restrict, and maybe I would say to review, to get explanations and ultimately to say yes.
Of course, when I say that, it is just complicating the procedures, and this is not what we are seeking. In the field of obesity, there is too much in terms of confusing and misleading information, and we should seek an efficient strategy to restrict that and to guide Canadians towards what is desirable.
It is far from being the case now. Occasionally, when I criticize a little bit more, I say that we live in a system that is imposing a lot of constraints to serious agri-food producers and that leaves almost an endless freedom to those wishing to say anything to anybody in any way. So there is something to do there. Restriction might be — yes.
Ms. Vanderkooy: Advertising is not education. Children can't understand the difference between it. In essence, it's unethical to think we are educating children when in fact we're exposing them to branding, and advertising is designed to promote.
We are limited humans. There is only so much food we can eat. It's one consumer good that we really don't have a choice on. We need to limit our consumption of this particular consumer good. We need our kids to not be distracted from healthy messaging and healthy habits. We need to give them a chance to develop healthy habits and hang on to them, and advertising is not making healthy eating the easy choice.
Mr. Vuksan: I generally agree, although I think false advertising is confusing not only for children but for everyone. We are all children when we see something nice and tasty.
I was confused the other day when Coca-Cola finally said they would have less sugar in Coca-Cola, and they reduced it from 10.2, I think, to 9.7 teaspoons. You can imagine how much you have inside. This sounds cool. My son said, "Dad, can I drink more now?''
I think we have to be careful. There is a wonderful organization, the Federal Trade Commission, in the United States, which is very restrictive, so you can't fool around. You have to say what is true. Anyway, I'm for restriction, rated 13-plus, whatever.
Senator Seidman: My questions are around dietary guidelines and food labelling. However, before I ask you about those, I want to ask Ms. Vanderkooy a specific question about one of the points she put forward in her presentation in regard to monitoring the food supply and surveillance data on food consumption patterns.
One of the questions we have, as we have had over the course of time, and as Senator Eggleton put forward is, it's clear, or is it, that there is an increase in the rate of obesity? We think there is but, of course, there are different ways to measure obesity and we may have changed the way we measure it and we may have changed our standards over time. But if we agree intuitively, and based on some degree of evidence, that there is a change in the rate, we would then have to ask what is causing that. One of the causes you put forward is a change in food consumption patterns.
You say, Ms. Vanderkooy, that the Nutrition Canada survey was in 1970, 1972, and then the Canadian Community Health Survey in 2004. First, is the data comparable in those two surveys? Second, has it been compared?
Ms. Vanderkooy: Those are excellent questions.
Going back to the obesity piece, there are measured data and reported data. I need not say that the one is less accurate than the other, but we have measured data and we know that obesity is on the rise.
We have food supply data that tracks calories per capita from the agriculture side, and we know that the food supply fed to Canadians has been on the rise, but we didn't know much about consumption patterns. We knew 1972; we knew 2004. What happened in between? Computers started to analyze data.
The answer is yes, those two sets have been compared. No, they were not compared by computer exactly because they were slightly different. They were coded differently. Canada's Food Guide changed in between, a number of these little details, but there are some excellent reports. Statistics Canada has released quite a number of 2004 analyses, but there has been good comparison back to Nutrition Canada where it was possible.
Senator Seidman: I think it would be important for us to see that data. Chair, could we ask or impose that?
If you do have that comparative data on consumption patterns, if you would be able to send it to the clerk of the committee, that would be much appreciated.
Ms. Vanderkooy: Yes.
Senator Seidman: On that note, you talk about consumption patterns and the type of food that's being consumed. The dietary guidelines in Canada were changed somewhat. They were modified in 2011. We talk a lot about advertising to children. If you look at the dietary guidelines on Health Canada's website, they are quite well presented from a presentation point of view. The question is, how accurate are they? To begin with, do you think they're good? How can we make Canadians more literate or educate kids about using Canadian dietary guidelines, if they're appropriate? I would hope all of you would respond to the current dietary guidelines.
The Chair: On the first one, Ms. Vanderkooy, if you could deal with that. But on the second one, we're not going to get into a lecture, so try to identify specific items to respond to the second part. Otherwise, we'd be on that all morning.
Ms. Vanderkooy: The dietary guidance we have is the most recent from Canada's Food Guide. On the back of that guide, it very specifically talks about foods to limit. The guide is good, but when you turn it around and you look at the foods to limit, that's the piece where we haven't really done well. If you were to talk about the new tobacco, it's the excessive eating of energy-dense, low-nutrition foods. They are acknowledged on that guide, and they are encouraged to be limited.
You had another piece in your question.
Senator Seidman: If we could just continue, because I'm really interested in what the other witnesses might have to say about the current dietary guidelines, what they think of them and whether they think they should be altered. If so, how?
Mr. Tremblay: I don't know if I can provide a direct answer to the question, but the point I would like to raise is maybe more a matter of provincial competence. It is really on education. The time has maybe come to think about making nutrition education, healthy eating education, a school-related discipline in order to have competent consumers with the potential to display better discernment. In Quebec, it has not been part of the tradition. I understand that this is also the case in many places elsewhere. It would certainly contribute to health and reduce the need for perfectionism about dietary guidelines.
Mr. Vuksan: I would actually make a couple of points.
On the first one, I don't think we have sufficient information in Canada, with all due respect to the enormous work of dietitians in Canada and Health Canada. We just don't know exactly how many are obese and how many are overweight. We have several surveys, and I've been trying to study them. If we have a meeting next month, maybe I'll know more.
Basically, we need more good studies, and not only as complicated as knowing what people eat, because dietary tools are not easy to use and interpret correctly, but just by measuring body mass index or waist or whatever is relevant at the level of obesity research. Earlier I gave you some confusing numbers I came across recently. We need more surveys of any type, as simple as obesity surveys, and I would say more dietary. We should probably have more on this.
We talk about what to say to children and what to say to adults. I keep on saying that with obesity, we're all the same, not only children, although children are the most vulnerable. Basically what's happening with us is small changes. We eat a few more calories each day. If you eat 30 more calories a day, every day, that's about one bite of bread. One slice is 30 grams, about 60 calories. You have to literally have half a slice more than you require, and in one year you have one extra kilo. Over 10 years, you have 10 kilos. So starting with children would be useful.
I think there is a lot of misconception. Again, I mentioned sugar. If you make a correlation of sugar consumption, say fructose, and obesity, you will have a wonderful 45-degree correlation in the last 20 or 30 years; but if you also look, for example, at the consumption of bottled water, you will have the same correlation. You know what I mean.
A student of mine in Toronto is a world expert on fructose. He's saying that if you actually eat fructose sugar, and if you eat — isocaloric is that if you don't eat too much, you will not gain more weight on fructose than anything else. We just simply eat more calories. I'm not saying we don't need education. We need to just look after calories and add more exercise.
The Chair: On the second part, please focus your question to see if we can get shorter answers to it.
Senator Seidman: I want to carry this over to nutrition facts. Mr. Vuksan talked about that just now, entering that issue, and nutrition facts are critical. If you think about the whole issue of nutrition facts, do we have real research demonstrating that nutrition facts on food labels, for example, is useful and actually has an impact and is successful?
Ms. Vanderkooy: I can address that. Yes, we have research about how consumers use the nutrition facts table and labelling.
These are the facts. We know that the facts are not really great at simple interpretation. Health Canada is aware of that. That would be another step, to take the whole nutrition facts piece and say thumbs up, thumbs down, whatever.'' We aren't there yet, but the nutrition facts are being updated right now and there are some features that have been proposed that I think will be really helpful. I hope some of those things go through, but I'm not the food directorate so I don't know that. We will find out when the Canada Gazette Part I comes out.
Senator Seidman: So you're saying there's evidence-based research to demonstrate that the use of nutrition facts is actually effective in getting people to purchase or not purchase certain foods?
Ms. Vanderkooy: It may be a purchasing factor, and it may be at the store. People don't understand DVs very well, the daily value. We don't have a database for people to compare at home, so there are limitations. Remember that, in the end, that's knowledge. Knowledge doesn't necessarily lead to a change in behaviour with eating.
[Translation]
Senator Chaput: My first question is for Mr. Tremblay. You talked about new factors that contribute to obesity including short sleep duration. Has much been done in the way of research or study in that regard? And, if so, would it be possible to get copies?
Mr. Tremblay: Yes, a number of studies have been done. In fact, we have known since the early 1990s about the link suggesting that those who sleep less are more at risk of being overweight. The Americans conducted lab research to determine the impact of limiting sleep on appetite control. The research revealed the short-term effects a lack of sleep has on the hormone profile involved in food consumption, appetite sensations, caloric intake at will, meaning the actual number of calories eaten, and the link to the risk of excess weight.
Many studies on the topic have now been done. Clinical trials are currently under way to determine the potential benefits of sleep duration changes on weight management.
In response to your second question, yes, of course, it is possible to provide you with those studies. The information is publicly available, as well. I can help get those to you, and the Canadian Nutrition Society would also be quite willing to help.
Senator Chaput: If I may ask, Mr. Chair, could we, at least, get the links to the sites where we can access the information?
Mr. Tremblay: Yes.
Senator Chaput: You can provide that information to the committee?
Mr. Tremblay: Absolutely. All I need to know is how to get it to you.
The Chair: Kindly send it to the committee clerk. Thank you.
Mr. Tremblay: Very well.
Senator Chaput: My second question is fairly short. As I listen to all three of you speak, it makes me think that my grandchildren have little chance of not winding up obese, given the reality they live in, the products available at the grocery store that young parents buy these days. Both parents work and don't have time to prepare homemade meals, as was the case in the past. Just consider a homemade meal of spaghetti, for example. Store-bought spaghetti sauce is likely to contain a large amount of salt and sugar. And that defeats the whole benefit of making a home-cooked meal.
You talked about the need to restrict television advertising aimed at children, and I agree with you. What can we do to help young families and parents who don't want their children to end up obese? Given the reality these days, we are almost fighting a losing battle. Young people aren't very physically active; they spend their time on the computer and other devices.
How can we get parents and families on board in order to break the vicious cycle of obesity? Could you give me an example?
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Ms. Vanderkooy: It was a conclusion in Mr. Merrifield's report in 2006 that our kids may not live as long as their parents.
Economically, the kids who are really at risk are the ones who already suffer with health inequities. I talked about the kids who are food insecure. In those families there is less chance of eating together because mom and dad are out working a few jobs at minimum wage.
If parents had the support, if they knew that they could make ends meet and be at home with their children to eat together, it would be a big step. How can we figure things out so that we can support families to do that? That would be one important piece.
If we had food education back in the schools and if it was modelled in such a way that the school was a place where it was so easy to make a healthy choice, because that's all that was available, I think that's the publically responsible thing to do. Model in a publicly funded setting and give them some food preparation skills at school. It would be great if it happened at home too, and it would if we prepared more meals together.
That's a quick answer.
Mr. Vuksan: That's an excellent question. Eating, whether it is children or us, is a family affair. Some people say fat parents make fat kids, but it's not only genetic. They share genes, but they share a table even more so. So I think these are very important.
I would say that children whose parents work more — and we have more of this situation — have fewer joint meals, so there is a lack of traditional lifestyle. We studied this aspect. When you live less traditionally, you are more prone to disease and obesity.
Also, you don't have this pattern of breakfast, lunch and dinner regularly, so you snack a lot. We also learned that snacking increases obesity. There is all sorts of confusion in this situation, but it's an excellent question.
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Mr. Tremblay: I'm not sure whether we can reverse the cycle of increasing obesity. But we have a duty to create the best possible living conditions for our children, whether that means healthy eating, good exercise habits or good sleep habits. During our meeting, we talked about continuing to invest in research in order to better understand the problem. For example, I submitted my most recent funding request jointly with some Danish colleagues in order to measure the impact of increasing carbon dioxide in the atmosphere on the energy component. I hope our hypothesis is never proven, in other words, that, as the carbon dioxide we breathe increases, the harder it is to control our appetite.
We are in a context where we still do not fully understand the possible causes of the rise in obesity over the last 30 or 40 years. We have to keep investing in good lifestyle habits and strive to gain a better understanding of the phenomenon.
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Senator Enverga: Thank you for the presentations.
It was mentioned a while ago that one of the issues around child obesity is food marketing. The question is: Do we really have to worry about the marketing? Should we worry more about the number of hours children are watching TV all the time?
Another note is that we've been doing a lot of programs, such as food nutrition, how good it is, but when you get to children, would you agree that changing the labelling would be good? Let's say if you drink so much of this pop, you put a picture of a mouse there if you drink once. If you put two, you become a pig or three people or a whale or something like that. Do you think we should be able to make it just like cigarettes? You put a picture there saying if you smoke, you will become like this. You will have this kind of illness. Do you believe this is one of the things that we could do, maybe make it more effective for children? When we look at these, they say calories. Children will think of it more like colours, and the more colours, the better. Do you think this approach of this type would work?
Mr. Vuksan: This is another difficult question.
I think that there are some positive moments. We have just now introduced on the labelling how much sugar is added, which is quite useful because they are these empty calories and you try to stay away. Although I try to protect sugar a little bit because we go to the other extreme.
This is another wonderful thing. A nutrition survey by the National Institute of Nutrition a few years ago looked at how many Canadians read food labels. I was astonished. Across the board, across education, age groups, over 50 per cent read labels. If you go in the stores you see people looking at the labels. Labels are pretty good to give you portions and I think it's good.
Your question about whether we should not advertise food and make sure they watch less television, these all go together. However, you have to remember that one small bag of chips — I had this on the airplane — is 150 calories. You will say, "That's not much,'' but you have to walk pretty fast for about 30 minutes to burn that energy. I would say if you have labels in the restaurants that say for what you're going to eat tonight, and you eat it all because you paid for it, you will need to walk so much — not the amount of calories, but how you have to do exercise — then you will think twice.
I was talking to Loblaws a long time ago, when we were working on this "Too Good To Be True'' line, that when you buy food, the bill could at least outline how many calories for each type. So then anything you buy automatically, you could divide in the household or whatever. It's about more information and education. Anywhere that you go, you are attacked with useful information and it will come to you. I don't think exercise only will do because we're not born to exercise, unfortunately.
Ms. Vanderkooy: Children need to be educated, but parents do the food choosing for little kids, so that would be one point. Kids are harassing parents, but at the end of the day it's a parent's responsibility to choose food, and it's a child's responsibility to eat to their point of feeling content.
Marketing is more than TV. If we take TV ads off that are directed to children, there's more marketing out there, and that marketing is also affecting them.
There is a stigmatization around obesity that we try so hard to avoid. We know that some are healthy at every size. We don't want to make fun of it or make it a bullying subject. We know that the research says there are genetic predispositions. I believe there's a huge stress involved with the health inequities of living in poverty. But, yes, there needs to be better interpretation on our labels to warn people that this is calorie dense and there's not a lot of nutrition.
All foods need to be labelled. Right now there's a bit of a loophole. We don't have food labels on foods in delis, for instance, and that has now become so standardized that we could do that; we need to regulate that. We don't have any kind of labelling in restaurants on food menus, yet that food is standardized — they know it — but the information needs to become available.
When I mentioned the nutrient database, do you know why people compare labels in the store? That's the only place you can compare them. There is no way to look at all the labels on the computer because we don't have a nutrient database that contains all of our foods by label.
This is the computer age. Wouldn't it be great if I said, "Show me all the crackers in the store and tell me which one is highest in salt''? We can't do it; we don't have that database.
These are the things that I mentioned, and I can go into the background of why I'm so passionate about that.
The last point I'd add is that physical activity is 20 per cent of our calorie needs. The main piece of our calorie needs comes from just running our bodies.
When I say I need 2,000 calories, about 400 or so are related to my activity level. If I consume an extra 400 calories, I have to double my activity level. I haven't doubled my calorie intake, but I have to double my activity output. It's pretty easy to eat a lot of calories; it's not quite so easy to wear that off again. That's where the balance comes in.
Imagine if that meal said, "You're going to have to run this off.'' Now, we need a basic amount; we know that. In essence, the menu in that restaurant is saying, "If you are now eating beyond what you need, then it's going to take you this long to run it off.''
Mr. Tremblay: On stigmatization, it is probably related to other unsuspected factors that were discussed here today. When you are obsessed, very preoccupied by your weight, whether it is because of magazines and advertisements or because of insisting in labelling, you change your intake, your appetite, and at least, in our hand, it is maybe a more important predictive factor compared to what we find on the plate. It is a very important issue.
Senator Enverga: Actually, my question is more related to stigma, not stigmatizing people. It's more like food labelling for children.
It would be nice when you have a box of chips that says that if you have one of these you will become a mouse, but if you eat three more you will become another kind of animal which is bigger. Maybe we could introduce that to our kids and force the companies to make sure that the labelling is clear.
The Chair: Can I rephrase the question? It's a good question. The issue is really modelled on the tobacco issue. Should there be labelling that causes food consumption to have the same dramatic negative context?
Mr. Tremblay: It will certainly be more difficult compared to tobacco.
The Chair: Right. Forget about whether it's difficult or not. Would that be a way to go? That's what the senator is asking. Yes or no?
Senator Cordy: Maybe.
Mr. Tremblay: Maybe.
The Chair: All right, it is "maybe'' for you.
Ms. Vanderkooy?
Ms. Vanderkooy: The literature says that, yes, there is value in an interpretive system. It helps with choices. It doesn't make all the behaviours change, but yes, there is helpfulness in a simple interpretive system.
The Chair: Dr. Vuksan?
Mr. Vuksan: Very simple answer: Yes and no. This is a great idea. I'm not sure about a mouse; I wouldn't want to be a mouse.
The Chair: Never mind that.
Mr. Vuksan: Okay, yes and no.
The Chair: It's the principle he's getting at.
Mr. Vuksan: I gave a concrete answer: Yes and no.
The Chair: Thank you. Overall, senator, it's a "maybe plus.''
Senator Frum: To the extent that we understand there's a problem, we understand there's no single cause. However, one of the non-traditional causes presented today intrigued me, because it doesn't get discussed very much at all, and that is that certain medications might be contributors to obesity.
A recent study showed that Canadians are among the pre-eminent users of antidepressants, for example. We know our children are among the pre-eminent users of marijuana. I read recently that antibiotics, once you destroy certain bacteria in your stomach, they never come back and that causes weight gain. When you're prescribed antibiotics for yourself or your children, it doesn't come with any kind of warning, maybe because it's not scientific.
I'm interested in which medications are you thinking about when you list them here. Is the rise in certain types of medications that we see in our society connected to this?
Ms. Vanderkooy: Yes, there are medications that are directly related to an increased risk for weight gain. You've correctly identified that these are especially in the field of mental health. With mental health conditions, it's really difficult to keep your weight down because most of those medications have that side effect. That doesn't help the mental health either.
Are there medications that will help us to lose weight? There is one product right now. There may be some others in the making, but the prevention guidelines said not to rely on medication. In other words, doctors, don't give your patients a pill. Measure them, and when they're really at high risk for chronic health problems, refer them on. I'd like to think he meant refer them on to a dietitian for some advice or a person who can help them with their physical activity patterns.
Yes, there are medications that make us gain weight faster. That's no fun. Because without changing our eating patterns, here we are gaining weight; it's very frustrating. And there may be some hope for medications that help us to lose weight. I'll warn you that some of them have quite interesting side effects, so not a perfect pill.
Mr. Tremblay: We have tested antipsychotics. Clearly they increase hunger. This is the main cause of withdrawal of the medication when they are supervised by psychiatrists. When we were matching physical activity with the antipsychotic therapy, we were reversing the trend; so weight loss instead of weight gain. It is probably the most documented category of medications.
Mr. Vuksan: If I may, 7.4 per cent of Canadians have diabetes. The diabetic medication, most of them — not maybe Metformin, which is insulin-sensitizer, but many others, including insulin — we have more and more people on insulin. That type of treatment will actually increase fat deposits. It's a big deal for people who are actually developing diabetes because they were obese, so this is a worsening case.
What happens with antibiotics is you clean out microflora, as you mentioned. We are talking about something called "job vacancy.'' Not that you clear, but you actually kill a certain family of bacteria and you just don't have metabolism and bowel movement which will actually help. Everything is now happening in the colon. This is all televised, so I can't tell you more about the details. Production on the other end is important.
Medications for weight loss are highly popular. There's only one — ORLISTAT — and hopefully the television will bleep when I say what the side effect is. If you touch dietary fat being on ORLISTAT, then you have spotted pants.
The Chair: Okay, we get the picture.
Senator Frum: I'm going to take another run at Senator Enverga's question. Can we say that certain foods are so toxic, similar to tobacco and alcohol, that we can consider the same kind of advertising bans, like certain foods that have negative zero nutrition and are just fat, sugar and salt?
Ms. Vanderkooy: I'll give you one example. It's difficult, but when caffeinated energy drinks were reviewed, our association said we'd like to see the warning for children and teens not to consume caffeinated energy drinks. It didn't go through. It was children. My definition of children doesn't extend to 18. I think most kids, when they're 18, wouldn't say they're kids. And yet the labelling continues to have that wording.
It's difficult to vilify products. I'm using a product class here, but if I was to be nanny state, there are a number of products on which I could set up some criteria to say not so great, high in calories, low in nutrition, based on cheap ingredients, add a little flavour, add a little colour and ta-dah, profit. Market it really hard, more profit.
How do we mark that? An interpretive system would help. Stopping the advertising because typically what's advertised? When was the last time you saw an advertisement for broccoli and carrots? Not a big profit maker. So we need to shift the paradigm, shift the environment, make it more health promoting and easier to make healthy choices.
Do we do that by vilifying some? Could we ever ask the industry to stop making this? Where's the will? That's partly an economic-political decision. There are people whose jobs depend on this.
I would say that if you look at the grocery store in general, if you took all of that food and mixed it in a pot, it's not so healthy. If you go around the perimeter you'll get a healthy diet. If you include all the stuff in the middle, it wouldn't make the best composite because some of those foods are just pushing it over the edge.
Mr. Tremblay: When we talk about toxins, it is also relevant to indicate that some of our foods still have small concentrations of pesticides and other persistent organic pollutants that are deposited in our body substance and which have metabolic effects — real toxins in this case.
The Chair: I'm going to move on to Senator Cordy.
Senator Cordy: Thank you very much. Your comments today have been informative, as were the comments from the other witnesses we've heard on this issue. We certainly understand it's a very complex issue and unfortunately there's not one single solution — if only there were.
A few years ago this committee did a study on the social determinants of health, and many of the things you're talking about today related to obesity would follow through on the social determinants of health. Recently people have come out and said that when families don't eat together, it increases obesity and poor eating habits, but also it leads to poor mental health, so it's a big tie-in.
Ms. Vanderkooy, you spoke about one in eight households that are "food insecure.'' You gave a few references, but what would you say is your definition of "food insecure''?
Ms. Vanderkooy: There is an 18-question questionnaire administered through the Canadian Community Health Survey, the CCHS, that defines food insecurity, and it asks very standard questions about food, because you don't have enough money. By definition it measures, at a household level, due to limited income, do you experience some of the following? The questions are things like: Do you ever worry about not having enough money to buy food for your family? Have you ever, on your own, because you had to, limited the amount of food that you were able to eat on a given day? Have you ever limited your food so that your children can eat? Have you ever gone a full day without eating?
Depending on how you answer those 18 questions, Statistics Canada puts you in a grouping of "food secure,'' and that would be about 88 per cent who would say yes. So I would expect those in this room to say, "Food insecurity, what is that?''
But the other 12.6 per cent in our nation answered either marginally food insecure, so they were worried about having enough money to buy food; moderate food insecurity, which means you're going without sometimes; or severe food insecurity, which is about 2.5 per cent. When we do nutritious food basket costings and we compare that with minimum wage, social assistance rates, it's pretty easy to see why these folks just don't have enough money after they pay the rent.
Now, don't think this means these people who are severely food insecure are necessarily going to be thin as a rake, because the elements are what you can acquire as best you can. Food banks maybe help out about a fifth of people who are food insecure, and maybe they only give about three days' worth of food in a month, so food banks are certainly not the answer.
Whatever food can be gleaned or sourced or go to a neighbour or a friend, the risk is high for malnutrition. On the outside, what does that look like? It may look like a normal weight or obese or thin, but the point is food insecurity is very stressful and terrible for kids. How do you learn when you haven't eaten and you know that your parents haven't eaten, or that your parent didn't eat because they wanted you to eat that last bit because the cheque is coming tomorrow, not today?
Senator Cordy: It's pretty hard to follow Canada's Food Guide when you're going to the food bank to get your food and you take what they give you, isn't it?
Ms. Vanderkooy: Yes. Food banks are not a food system. They're like that sort of satellite piece that charities have organized with all of the best of intention.
Senator Cordy: I'm wondering, too, about communication and advertising. Corporations spend millions of dollars advertising foods mainly high in sugar, fat and salt. Ms. Vanderkooy, you said advertising is not education, but clearly it works or they wouldn't be spending that amount of money on it. You talked about food labels. I read food labels when I go to the grocery store and look for low sugar, but it's high in salt. I look for low salt, and it's high in sugar. I look for low sugar, and it's high in aspartame, which I wouldn't want either. It's a challenge and I'm literate, but there are thousands of Canadians who can't read food labels, so they're dependent on another form of communication.
You spoke earlier about the challenges of communication and ensuring that stigma is not attached to it. I was an elementary school teacher, and I can assure you that the greatest stigma against children was against children who were overweight. I would say nothing else even came close to the stigma for children who were overweight.
How do we communicate, keeping in mind that we have to be aware of the stigma and that it's the children who are being bombarded with the advertising and asking their parents to buy things? It's the parent who should be making the decision. How do we go about communicating so that it's easy communication? Some people say that you have 30 seconds or less to give your message. How do we communicate with the general public about the importance of good diets and lifestyle and the whole gamut, because it isn't just a one-shot solution?
The Chair: We're getting back to the issue of what the label looks like. Can you focus it?
Ms. Vanderkooy: It's all well and good to talk nutrients, but you need to have a simple message that talks food. That's why Canada's Food Guide is food. People don't eat nutrients; they eat food. Michael Pollan says to eat food that your grandmother would recognize and not too much, mostly plants. That message is very simple and very important.
Senator Cordy: Is there something working now? Is television working or is it the Internet via social media? Is some communication to promote good nutrition working better than others?
Ms. Vanderkooy: In the classrooms, yes. Canada's Food Guide is one of the most-used resources in Canada. I heard that it's next to the income tax form. Yes, some good teaching is going on out there, but the competition to distract us with different messaging is very compelling, with different messages and visible distractions. They outweigh the educational efforts. Look at the budget for public health campaigns and compare it with the budget for food companies and you'll see that there's no comparison and the messaging is very different. One is promoting health and the other zeroes in on where they can get you to buy because that's their purpose.
Mr. Vuksan: If I may quickly add, the answer is very difficult as someone has to see what works best.
I often teach secondary school students and have different talks. Their favourite talk is about Canada's Food Guide, and I must tell you with all respect that they know nothing. They don't even know the basic calories of proteins, carbohydrates, et cetera. I agree that for understanding nutrition, not only in that aspect but also clinically, we are turning to food; but people know little.
The other dangerous aspect in educating children to reduce weight is the opposite of obesity: anorexia and all these kinds of things. Every time I talk about body weight to young people, I'm very cautious, because they are prone to anorexia and bulimia, where you cannot do much.
Senator Manning: I thank our witnesses for their testimony this morning. It's a very interesting conversation we're having.
I would like to get back to a comment made earlier, I believe by Dr. Tremblay, concerning legislation in place in Quebec in relation to advertising to children. I was not aware of that. How long has it been in place? Are there any studies or reports that we can lay our hands on to show whether this is working? Maybe you have some comments on exactly what that's doing for the Quebec population versus the rest of the country.
Mr. Tremblay: I don't know when it was implemented, but it was some years ago. I am not aware of data demonstrating the impact on children. In fact, the legislation prohibits, at the first level, advertisement to children.
I remember many years ago a well-known company that commercialized a cookie. On the label was Igor, a small person, difficult to describe but attractive to children. That was amended because of the specific attention to children.
Maybe there is information about the impact, but my understanding is that there is a message of no advertisement to children.
Ms. Vanderkooy: It was about 20 years ago. There is some problem with bleed-in from the U.S. and other provinces. It obviously would be much stronger if our whole country had the same laws so Quebec wouldn't be a little province on its own trying to implement this.
Yes, some studies have been done. There are impacts. Remembering that this is one province trying to do it alone, I believe I read something about a lower rate of childhood obesity in Quebec at one time. I would be happy to drum up some information on that.
I also need to emphasize that this is not just a Canadian idea. The World Health Organization has strongly recommended this. From 2012, there are several strong recommendations to do this. I know it's a big jump, but it's out there. The literature supports it. In Canada we have a little micro-experiment that has been brilliant, and we think it needs to be extended nation-wide.
Senator Manning: I want to touch on Canada's Food Guide in a different way. I grew up in a family where the family meal was important. Our society today doesn't promote family very much, or promote the family meal any longer. I'm just concerned. We spent a lot of time this morning talking about children, but it's the parents that we need to get to, as they make the decisions.
I live on the Island of Newfoundland where 85 per cent of fresh-food healthy choices are trucked in. In the wintertime, it's very difficult because they have to cross on the ferry. Plus in the wintertime, seniors especially don't get out to walk or get other exercise in any way, shape or form. We have a serious issue with our children, but we also have a serious issue with our seniors in relation to eating properly, obesity and other concerns they may have.
Somebody suggested a while ago that we should include something in the monthly OAS payments showing Canada's Food Guide and information on proper eating, and to do this continuously over time to address that. Is there any effort that you are aware of that's been known to promote healthy eating among seniors along with everybody else? It's a segment of the population that I'm concerned about in terms of proper eating.
Ms. Vanderkooy: There are campaigns that focus especially on vegetables and fruit. If I were to take one food group from Canada's Food Guide, it's the one that's important to promote. It's like a marker, so to speak, for healthy diets. There are a number of different programs, such as the "5 a Day campaign'' and "Colour your plate!''
Newfoundland is one of the more remote communities. I talked about vulnerable communities when it comes to accessing nutritious foods. Somehow we need to support that. There was a recent report on Nutrition North Canada — although there are some pieces we have to fix; about everyone having access to nutritious food.
I would say that in your province the statistics have been somewhat promising in that at least you've tackled your food insecurity rate a bit. The suggestion from a CIHR study being done right now with Valerie Tarasuk is that with income supplementation — putting money into the pockets of people who are food insecure — they buy food for their kids.
The Chair: The specific question he asked was: Is anybody aware of a program aimed directly at seniors?
Ms. Vanderkooy: Seniors? No.
The Chair: Okay.
Senator Nancy Ruth: I'm old enough to well remember that in payment cheques there were inserts on nutrition.
The issue I wanted to raise is satiety, though. You have all talked about calories rather than satiety. I know that I can eat two and a half apples for that small bag of chips and have the same calorie intake, and I'll be as full as a whale, senator. So I want to know why you don't talk about that, why that isn't just as important as calories. If I were doing an advertising campaign, I would focus on satiety, not calories.
Mr. Vuksan: Satiety is only one aspect of eating. If you have satiation, it means that you are able to stop in the middle of a large meal and say, "I've had enough,'' which is very hard because it takes approximately half an hour for the hypothalamus to figure out what you have in your belly. Satiety is something that will prevent you from eating too much for the next meal. The whole case of obesity is too complex. More satiety doesn't mean eating less. If we eat less, it doesn't mean that we will lose weight. It's very complicated. I don't know many studies that have a strong correlation between satiety itself and weight loss. There are more elements involved.
Mr. Tremblay: As Dr. Vuksan indicated, it is complex, and there are technical aspects behind satiety.
We prefer talking about healthy foods, healthy eating. When it is implemented, healthy eating is promoting satiety with a reduced caloric intake. So healthy eating is considering the satiety issue. So we are not insisting so much on the technical details. Occasionally, we have controversies between ourselves regarding the meaning of satiety. So, for the general public, healthy eating is much better terminology and embraces the satiety issue.
Ms. Vanderkooy: Satiety is also related to a balance in the diet. In technical terms, protein and fat in a meal helps the satiety, but we talk food because food is our language.
We also know that when you drink your calories you don't have the same satiety, and your body doesn't understand that oops, there went 200 calories right down the drain. So there is a reason why taxation measures have been proposed and focus on sugary drinks, because we have a lot of sugar in our diet and don't get that satiety out of sugary drinks.
So, yes, we think about these things, but the end piece we don't talk about a lot. Fair enough. I think you'd be great on the team, and that would indeed be a good message there.
Mr. Vuksan: Can I add just one thing against what I said before, in favour of your thought? Actually, Health Canada is now, as we speak, looking through the document. They want to offer satiety claims on the food label. We discussed this six, seven months ago. Hopefully, this will come out, as some foods are more satiating than others. That will be something for you to read.
The Chair: Good luck.
I'm going to go to a question each from Senator Eggleton and Senator Seidman, and them I'm going to ask a question left by Senator Raine, which corresponds to one I want to ask. Then, I'll follow up, and we'll conclude at that point.
Senatort Eggleton: I'm glad poverty has been mentioned here because a previous study by this committee indicated a link between poverty and health — that the bottom quintile of Canadians use twice the health services in this country as the top quintile. So there is quite a relationship between health and healthy eating and poverty.
My one question deals with the deluge of information, books and everything that is thrown at the public in this country, and other places as well, about diets, ways of losing weight, overcoming obesity. There are books out there and television programs. There are all sorts of columns. They talk about different food substances, one day, as being very good. Another day, the opinion changes somewhat. What's good one day may be bad another day or vice versa. This is a massive amount of information and very difficult for the public to sort through as to what, in fact, is good for their health in terms of what they consume.
What advice would you give to Canadians on how to determine and maintain their weight or lose weight? What kind of processes should they follow?
Mr. Tremblay: In one sentence, the advice would be to do their best to have healthy living — healthy eating, being active — and not focus so much on body weight. If it is well done, the impact on body weight will necessarily come.
Ms. Vanderkooy: Enjoy real food, and don't think that we're trying to be the food police when we promote real food. We're not. We're just really, truly trying to promote good, healthy eating and good, healthy habits.
Mr. Vuksan: I think we need more research to understand actually what to say to people. That's going a long way; I have a conflict of interest here. That's why we have this misleading information — one day this and one day another thing. Nutrition studies are not well supported because there is not much profit there like in pharmaceutical studies. Healthy living first: Focus on plant food, eat like gorillas and be more active. That's how I learned my eating, by doing the Paleolithic diet, gorilla diet. Eat vegetables all day long. I continue doing this.
Senator Seidman: I'm going to ask you about a different kind of recommendation, actually. As parliamentarians and legislators, we're concerned about making meaningful recommendations from our work. Following these hearings, we're hoping to make meaningful recommendations.
I'd like to ask all three of you: Based on your research, if you had one recommendation to modify current policy or to inform future policy, what would it be?
The Chair: If you don't have it right at hand, we would like the answer, in any event, and you can give it to the clerk. It's a serious question and we want a serious answer. If you can answer it now, please do, starting with Dr. Tremblay. If not, tell us you'll get us that answer.
Mr. Tremblay: I might come back, but not now, okay?
The Chair: Okay.
Ms. Vanderkooy: Policy and regulatory support for healthy eating environments.
Mr. Vuksan: I'm not brave enough to answer. I can get back to you.
The Chair: I know — you want more research dollars.
Mr. Vuksan: Yes, but not only for me. You can give them to better researchers, but we need more to study.
The Chair: It's a very serious question. You're not compelled to answer the question, but if you could, it would be very nice to have a focused answer. You've all made recommendations in your documents. We have those. The senator's question is: What is the most significant single recommendation you would make?
I'm now going to move to another question. Senator Raine has just been appointed to our committee and had another committee she had already been committed to. She left a question along the lines of one that I was going to ask you, so I'll ask on behalf of Senator Raine and myself.
Dr. Vuksan, in your slides you showed a 200 per cent increase in the problem for the period starting in 1985. The question is: Did this rapid increase coincide with the rapid advance of the low-fat diet and the substantial movement to the carbohydrate diet, which industry jumped on and loved greatly? There was a very dramatic point.
I am aware of the books that have been written that tie into this and the very significant issues around this, so I want to ask you the question the way Senator Raine put it: Does it seem to you that there is a coincidence in the increase in the rate of obesity with roughly that transition?
Mr. Vuksan: I will try to answer this. I would say no, or maybe not. I will tell about a one-year study where they put people on the Atkin's diet, with lots of protein; and Dean Ornish, the charming doctor from Berkeley who will give people lots of carbohydrates; and the Zone diet, which is the glycemic index; and Weight Watchers. It was four leading diets. They published this study in 2001 and found that all are the same. Everybody lost a similar quantity. It's calories, I think. It's just a coincidence because we're still dwelling on whether you should eat more carbohydrates, less of this and more vegetables. So I think it just coincides and you can't change these trends.
Ms. Vanderkooy: If you're focusing on obesity as the outcome, then it is calories. I would urge us to think about health outcomes, because that's the piece that's costing us a lot of money in the health care system. If you talk about health outcomes, preventing disease, there are some nutritional options that help to describe the kinds of foods that we recommend. Nutrition is a fairly young science.
So, yes, the research was a little bit vague and the food industry tried to jump on a few aspects, but we're getting closer and closer. We know that it's about food and not as much about manufactured products.
Mr. Tremblay: It's not so obvious. The increase occurred in the 1980s and 1990s. At that time, the food, the macronutrient transition, was not so pronounced.
The Chair: I have another slightly different question for you. Is there is a clear correspondence between life expectancy and obesity? To put it another way, is there a clear connection between a decreased life expectancy and obesity? Is it clear?
Mr. Vuksan: I wouldn't say. Although we had wonderful figures — you increase lifespan but you die sooner, so I don't quite understand 3 and 4 per cent.
I've seen speakers at the major conferences and they talk in favour of obesity, so I am probably at the wrong committee here. If you're a little obese, you hang on a little longer. I must say, it's not clear cut.
Mr. Tremblay: This is difficult to answer because it seems that we are talking when two phenomenon: voluntary weight change and involuntary weight change. If you are losing weight because of a cancer, you are normally progressing in a good direction for body weight, but are in very bad shape. It is intervening in the issue.
Ms. Vanderkooy: Yes. We can't make a direct relationship in number of years. We certainly would have a lot to say about the quality of health as it relates to —
The Chair: The reason I asked the question is that an expert has recently been advocating the idea that we should simply leave obesity alone and not try to be a nanny state with regard to all these issues. There is the issue of trying to claim that obesity has a huge negative impact on society due to the cost to help, which increases health costs, and is then offset by a lower life expectancy. So I don't want any more discussion on this. I just wanted to get your reaction on that.
Do you have a quick point?
Mr. Tremblay: A very quick point: We need more information on life expectancy without disease.
The Chair: But that doesn't help me here.
I now want to go to the complexity of the issue overall. Senator Eggleton raised this issue and you have each referred to it in your answer. This is the difficulty that we are going to have. This is a very complex issue. The human body on its own is a very complex organism. The variety and range of human characteristics is enormous, and the complexity of life experience is vast and highly variable.
In a report, it's no good for us to talk about recommendations regarding the complexity of the body system and go on at great length with theories and all this sort of thing. The issue that we are facing — and it was why I really liked Senator Enverga's question — is that if we could identify issues or ideas that are very clearly impacting this issue in a negative or a positive way, then we have a chance of making recommendations that could be implemented in some way.
We all know about the long discussion, over the course of my life, about diet and healthy foods and every conceivable way to get kids to eat broccoli, but that's not the answer. It is part of the issue, but it's not the overall answer.
The idea of the analogy with food labelling led to the discussion of high energy drinks, and there's recently been a great deal of publicity on the danger of those drinks. It's not just for kids where it's a problem. It's not just for non- athletes where it's a problem. In fact, one of Canada's superstar hockey players was used as an example. In a single game they cannot burn off the calories consumed from one of these energy drinks.
The point that you have all made and that others have been making — and I thought you put it very well, Ms. Vanderkooy — is the idea that if you eat another 400 calories, you have to double your total exercise pattern. I get a great kick of being in a fitness room and people are on the stages, looking religiously at the number of calories they're burning and so on. You've just burned your 200 calories, but nowhere does it show that that's half a serving of such and such. We're not going to argue that the exercise they did wasn't good for them. In many ways, it was. Much of the psychology of the exercise that is being done is to deal with the calories that they're eating. In today's world, you'd have to exercise virtually all day to deal with this issue on a societal basis. I'm speaking broadly here. I'm not talking about those who are naturally fit.
So when Senator Enverga asked you about the mouse analogy, Dr. Vuksan, I was thinking about your gob of fat there. What you could do is show a photograph of a person eating high-density problem foods, and then flash photo of your gob of fat. This is what you are going to look like in some area. If you don't like the mouse example — we went through the mouse example.
It would be exceedingly complex doing something like this, even if you could identify what you thought was a rational way to go, because you're dealing with people's lives in a societal sense. Our ability to act on that, as we have done in the case of cigarettes, needs a very clear focus. I'm not going to explore it further with you today. A couple of comments you've made suggest that you're not entirely sure that the sugar issue, on its own, is a baddie. I think there is growing evidence that sugar is a serious baddie and that it may actually be bad enough to the extent that would warrant a clear focus on it.
Thank you on behalf of the committee, for your testimony today. You've already agreed to provide the clerk with certain information. You answered Senator Seidman's question, a specific recommendation, but I would like to ask you if you could, in all the experience you've had — and together you represent an enormous amount of experience in this area — identify a single dramatic labelling focus. Maybe it's a single food item you would identify and say, "Yes, sugar is it; go after sugar with cannons blazing,'' or a specific strategy that you could think of. If you would be so kind, if you think of one, in addition to the recommendations — I'm not ignoring all the good stuff you've put in your documents to us here today, but if you could be so kind as to write the clerk and give her that suggestion.
I do very much appreciate your efforts to answer all the questions that have come up today, and my colleagues for the range of questions they have asked you in this very interesting study that we're doing.
(The committee adjourned.)