Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue 34 - Evidence - May 13, 2015
OTTAWA, Wednesday, May 13, 2015
The Standing Senate Committee on Social Affairs, Science and Technology met this day at 4:15 p.m. to continue its study 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 am Kelvin Ogilvie from Nova Scotia, chair of the committee. I will invite my colleagues to introduce themselves, starting on my left.
Senator Eggleton: Art Eggleton from Toronto. I'm deputy chair of the committee.
Senator Raine: Nancy Greene Raine from B.C.
Senator Enverga: Tobias Enverga from Ontario.
Senator Seidman: Judith Seidman from Montreal, Quebec.
The Chair: Thank you, colleagues. I remind you that we are continuing our study. We were directed to examine and report on the increasing incidence of obesity in Canada, causes, consequences and the way forward.
I am delighted that we have three organizations represented today. I will welcome them in the order that they are listed on the agenda, since there was no battle as to who will go first or last.
In that event, I will invite Manuel Arango, Director, Health Policy, Heart and Stroke Foundation of Canada to start, please.
Manuel Arango, Director, Health Policy, Heart and Stroke Foundation of Canada: Mr. Chair and committee members, on behalf of the Heart and Stroke Foundation of Canada, I would like to thank you for the opportunity to appear before you today to discuss our perspectives on obesity in Canada.
First and foremost, I would like to express our gratitude to Parliament for a number of initiatives and commitments that will help reduce the impact of obesity as a risk factor for heart disease and stroke in Canada. This includes the Budget 2015 investment in public transportation. This will help improve physical activity among Canadians. The reason for this is that commuters, on average, walk and/or cycle 30 minutes to and from transit stops/stations. So investments in public transit help with physical activity.
As well, there have been consultations on the nutrition facts table that Health Canada has been undertaking. We provided input on that and we hope that a new proposal will come out soon in that respect. That will be very helpful.
Finally, there is the improvement in the Children's Fitness Tax Credit, in particular by making it refundable. That will help with accessibility for lower income Canadians to have access to this credit.
Obesity shortens lifespan, reduces quality of life and limits productivity. At present, approximately six in ten Canadians are either overweight or obese. It has become problematic amongst children, showing up at younger ages and tripling within the last generation. The issue with obesity is that when it begins in childhood, it typically tracks into adulthood. It is important to address it early on.
This issue is a societal one that requires truly a coordinated and comprehensive governmental response. Obesity is not simply an individual issue that involves simply lack of will power or lack of knowledge. It is much more than that. It requires interventions at all levels of society, from institution to community, to all levels of government. It is widely recognized that obesity prevention and management require much more than just education. We know that there are population level interventions that truly work. This is the lesson we have learned from tobacco control.
We need to make systemic change and change the environments in which we live so that we will enable Canadians to live healthy lives. This approach is not only essential to ensure a healthy and productive population but is of paramount importance to preserving precious health care resources.
Today I will offer you several areas of opportunity for your consideration.
The first relates to physical activity and, in particular, active transportation. We live in a world where convenience has become the norm. This impacts both the food we eat and the way we spend our time. For most Canadians, both young and old, sedentary behaviour accounts for a large portion of our day. Many of us sit at offices and desks all day or we unwind in front of a TV or computer. We drive sometimes short distances compared to the past or we take the elevator because it is the norm. We are much more sedentary than in previous years. However, increasing our activity levels doesn't need to be as complicated as joining a gym or participating in a team sport. We can simply change the way we get around.
Almost all Canadians can improve physical activity rates through active transportation — that is, using human power to get from point A to point B. This includes walking, biking, skating, wheeling, running and taking public transit, as I indicated earlier. In order to facilitate this, we need health-promoting infrastructure such as sidewalks, cycling lanes, et cetera. We don't have sufficient and adequate health promoting active transportation infrastructure in Canada. We need more investment in this area.
Research demonstrates that those who live near infrastructure which supports active transportation are more likely to be physically active. Also, countries with higher rates of active transportation have lower rates of obesity. This is why the Heart and Stroke Foundation of Canada has been working with the Federal Active Transportation Coalition, which involves a number of groups, including the Canadian Automobile Association, the Canadian Urban Transit Association. The Canadian Cancer Society has also been involved, and many others. We have been calling on the federal government to invest $250 million over three years in active transportation infrastructure.
The second area pertains to nutrition and, in particular, nutrition labelling. More than ever, Canadians are eating ready-to-eat and processed foods. Canadian data on diet from 1938 to 2011 paints a clear picture of troubling eating patterns. There has been a massive replacement of whole, unprocessed or minimally processed foods with ready-to-consume and ultra-processed food products. There has been an increase in processed foods from 29 to 62 per cent of overall consumption over the years I mentioned, namely 1938 to 2011.
What does this mean for our health? Processed foods are high in sodium, fat and sugar and are the main contributor to the obesity epidemic. In fact, poor diet is the leading cause of obesity. The Heart and Stroke Foundation of Canada recommends that Canadians eat mainly whole and unprocessed foods and limit the number of times they eat out or choose convenience foods. This approach to eating has been recognized as an effective solution to curb obesity and has been adopted in the new and much heralded Brazilian food guide. We think Canada should follow a similar path.
Nutrition labelling can help guide Canadians to pick healthier choices. Ideally, we need a mandatory front-of-pack or point-of-purchase nutrition labelling system with a simple logo to help guide consumers. In addition, we need an improved and easier to understand nutrition facts table. The Heart and Stroke Foundation of Canada has certainly been providing feedback in the consultations that Health Canada has been holding with respect to the nutrition facts table.
This leads me to my third area, sugar. There is mounting evidence linking excess consumption of sugar to adverse health outcomes, including obesity. The Heart and Stroke Foundation recently put out a position statement on sugar and recommended thresholds for added and free sugars. This aligns with the World Health Organization recommendations. We believe that the nutrition facts table revisions coming out soon are a good opportunity to address the issue of added and free sugars.
In particular, we're quite concerned and feel that Canada needs to address sugary drinks which are the single largest source of sugar in our diet. Experts point to sugary drinks as a leading driver of obesity. These drinks mostly have no nutritional value, or very little, and only health risks when overconsumed. In fact, an adolescent would have to run for 50 minutes or walk 5 miles to burn off the calories found in a 20-ounce bottle of pop, sports drink or fruit juice.
The Heart and Stroke Foundation of Canada recommends that the government not only educate Canadians about the adverse health effects of sugary drinks but also create supportive environments to reduce consumption. We suggest using economic options like a manufacturer's levy on sugary drinks. The revenue from this levy could be used to make healthy eating more affordable by subsidizing fruits and vegetables and/or funding a universal healthy lunch program for students.
On a related note, agricultural policies have great potential to improve eating habits and reduce obesity. Higher levels of fruit and vegetable consumption are associated with lower obesity rates, yet consumption in Canada of fruits and vegetables is quite low. Improving affordability of fresh produce can be achieved through federal and provincial subsidies of local producers. In particular, improving affordability, access and availability are of paramount importance in rural and remote northern regions. We need dedicated strategies to overcome barriers to healthy eating and food security in these areas. I think my colleague from the Canadian Diabetes Association will elaborate on this more.
Lastly, we know we can influence eating habits from the start by restricting the commercial marketing of food and beverages to kids. Marketing to kids is associated with food preferences and choices, including higher intake of fast foods, and is linked closely with obesity. Regulations around marketing to kids are considered to be the most cost-effective option to prevent childhood obesity. The Heart and Stroke Foundation of Canada urges the government to protect the health of Canadians through this approach.
In conclusion, we know that no one intervention will solve the obesity epidemic in Canada. We need a multi-pronged approach to do this, one that really involves policy solutions at all levels of society. Canadians deserve support from the government that will allow the healthy choice to be the easy choice.
Thank you very much.
The Chair: Thank you.
I will now turn to Dr. Jan Hux, Chief Science Officer for the Canadian Diabetes Association.
Dr. Jan Hux, Chief Science Officer, Canadian Diabetes Association: Good afternoon honourable committee members. Thank you for the opportunity to speak with you today about a vital matter that impacts all of us — the alarming increase in obesity in Canada.
As mentioned, I am the Chief Science Officer at the Canadian Diabetes Association. I speak to you in that capacity because being overweight or obese is a major risk factor for Type 2 diabetes, a disease that is imposing a large and growing burden on Canadian society. Currently, more than 3 million Canadians have been diagnosed with Type 2 diabetes and in the next hour 20 more will be diagnosed. Accordingly, the increasing percentage of our population that is overweight or obese is a major concern for us. Let meet explain further.
Diabetes is a challenging disease to manage and the effort to do so is aimed at the short-term control of blood sugar levels. That effort is essential, but regardless of how well you do that, diabetes puts you at risk for complications which cannot be reversed. Diabetes sends thousands of Canadians to hospital emergency departments every single day for heart attacks, strokes, kidney failure, amputation and blindness. Because of these and other complications, people living with diabetes can expect to live 5 to 15 years less than someone without diabetes. People with diabetes don't die of diabetes; they die of its complications.
We know that obesity is a major risk factor to Type 2 diabetes and, in turn, that growing rates of obesity are an important driver of the diabetes epidemic. Reducing the rate of obesity is critical for the health of Canadians and for the sustainability of health care system.
Certainly, Canada's obesity problem is complex. Many people are tempted to oversimplify it, to "eat less, move more." The reality is that we need solutions that meaningfully address the complexity of the problem. Any solution set needs to recognize not only that individuals but also governments have roles to play. Just as the success we have achieved in reducing smoking rates slows, governments can act in ways that help us make healthy choices.
Now let's look around us. As we experience every day, the world we live in encourages us to gain weight. The two most obvious factors are the calorie-rich food we consume and our increasingly sedentary lifestyle. I will focus my comments and recommendations on promoting better food choices.
My first recommendation is to help Canadians reduce their intake of sugar-sweetened beverages through taxation and awareness. The evidence here is clear: Consumption of sugar-sweetened beverages is connected to obesity and Type 2 diabetes. People who consume more than one sugar-sweetened beverage or fruit juice serving a day have a higher risk of developing diabetes. A 2004 study showed that women who consumed two or three sugar-sweetened beverages per day had a 32 per cent greater risk of developing Type 2 diabetes compared to women who consumed less than one such beverage per month.
Taxes are a way the federal government can influence consumption. Several studies show that beverage consumption is price sensitive. These studies estimate that a 10 per cent increase in beverage price reduces overall consumption by approximately 8 per cent. Revenues generated from such taxation can be invested in obesity prevention programs.
On the awareness front, the Drop the Pop program from the Governments of the Northwest Territories, Yukon and Nunavut is an encouraging example. The idea is that the schools encourage students to drink water instead of pop. The program is off to a good start and we are following it closely to look at ways to support it. We hope that you, as federal representatives with particular responsibility for our northern territories and Aboriginal Canadians, will support it as well.
The second recommendation is to offer ethical and accurate nutrition information to Canadians. We want to achieve two things: restrict marketing to children and, like our friends at the Heart and Stroke Foundation of Canada, have clearer nutrition labels.
Current voluntary restrictions on advertising are not effective enough. It's time to be serious about protecting our children. Junk food ads are everywhere — on TV, at the movies, video games, toys and children's events. As a society, we are responsible for protecting our children, who may not yet be able to critically interpret and understand advertising information and its intent.
The CDA recommends an expansion of Quebec's Consumer Protection Act, in place since 1980. It prohibits all commercial advertising directed at children under 13 years of age.
It is worth noting that the House of Commons Standing Committee on Health recommended that the federal government assess the effectiveness of self-regulation as well as the effectiveness of prohibition in the province of Quebec, in Sweden and in other jurisdictions; to report on the outcomes of these reviews within one year; to explore methods of regulating and advertising to children on the Internet; and to collaborate with the media industry, consumer organizations, academics and other stakeholders as appropriate. That was eight years ago. We still need leadership in this area.
Also dealing with the question of nutrition information is the need for better labels that include the total amount of sugar in a product, both natural and added.
The third recommendation is to reduce food insecurity and promote healthy eating in vulnerable populations. Food insecurity and obesity are strongly linked to low income. Less healthy foods tend to be less expensive. Therefore, people with lower income face limited access to affordable, high-quality food to stay healthy and avoid obesity.
However, a successful program that guides healthy eating is the Canadian Diabetes Association's Food Skills for Families Program in British Columbia. It targets low income, new immigrant, Aboriginal and seniors populations. It educates participants about how to eat well by creating easy meals using fresh, whole ingredients and by learning how to read food labels. Expanding this program across the country, especially in Aboriginal populations, would promote economical and healthy eating.
Again, I want to thank you for your interest in this vitally important topic and for the invitation to speak with you. I look forward to continuing our conversation and answering your questions.
The Chair: Thank you very much.
I now want to welcome Joelle Walker, Senior Manager, Public and International Affairs for the Canadian Cancer Society.
Please proceed, Ms. Walker.
[Translation]
Joelle Walker, Senior Manager, Public and International Affairs, Canadian Cancer Society: I'd like to thank the committee for the opportunity to appear today. I am going to give my presentation in English this afternoon but I would be happy to answer questions in English or French.
[English]
I am sure that over the course of the hearings you have heard a great deal about the scope and magnitude of the overweight and obesity problem in Canada. We know that obesity rates have been steadily increasing over the past four decades and that for some groups the problem is particularly acute. I would like to focus my comments today on the correlation between body weight and cancer and offer some thoughts on the causes and potential solutions.
Because I am the third speaker here this afternoon, you will probably find I am repeating a lot of what my colleagues have said, but I think that reflects the growing consensus within the health community that there are a few things that we know will have impact on obesity rates in Canada.
We all know that tobacco causes lung cancer. However, only about 30 per cent of Canadians know that there is a link between being overweight and an increased risk of cancer. It may surprise you to hear that about a third of all cancers can be prevented by eating well, being active and maintaining a healthy body weight. Besides not smoking, having a healthy body weight is the best thing you can do to protect yourself from cancer.
People who are overweight or obese are at an increased risk of a number of cancers, including breast, colorectal, esophagus, gallbladder, kidney, liver, pancreas and uterine. They may be at increased risk for developing advanced prostate and ovarian cancer.
In terms of actual numbers, we estimated in 2007 that anywhere from roughly 5,000 to 8,000 of all cancer cases in Canada could be attributed to excess body weight, and research is producing more evidence every day.
We know that simply knowing the risks associated to being overweight or obese is not enough to change behaviour. At an individual level, obesity can be attributed to how much energy you consume and how much energy you expend. Is it more the "can" than the "couch"?
We know that the biggest contributor to obesity is food consumption. However, what drives increased food consumption has largely been a shift in our food environment. Unfortunately, there is no silver bullet — the causes of obesity are complex and are related to social, economic, psychological, environmental and political factors.
I am an educated woman and employed. I come from a privileged background and I work in the health sector. Despite all this and the fact that I am an expert in the field, I still struggle to manage my weight and understand the confusing world of nutrition and making healthy decisions. That is why it is important to make the healthy decision the easy decision.
As my colleagues have said, there is no one policy option or single program that will solve the increased incidence of overweight and obesity in Canada. The tobacco control field has underscored this clearly. Although public education is necessary, it will not have a sufficient impact unless it is combined with a variety of other measures.
Today I want to emphasize the role that governments can have in helping to shape policies that support food preferences. The federal government specifically can play a strong leadership role in implementing policies and programs that will have an important population health impact across the country.
We also recognize that governments cannot do it alone. We need coordinated action across all levels of government and across a number of different sectors. This is why groups like mine advocate for a comprehensive approach with policy options that will help people make healthy decisions.
My colleagues have eloquently spoken to some of the options, but I would like to highlight five, in particular.
First, improved nutritional labelling: Currently, almost all prepackaged food requires to be labelled with a nutrition facts table that provides important information about the nutrients and calories in any given amount of food. The table is intended to help consumers choose products more easily and compare a similar product to make better food choices, but we also know that the current format of the nutrition facts table is not sufficient. In 2013, a report from the Conference Board of Canada suggested that only 38 per cent of Canadians considered themselves to be very knowledgeable with regard to nutrition literacy. Health Canada is in the process of revisiting this table. We have provided feedback on some of the improvements we would like to see, but we are urging the government to look at more substantial changes such as front-of-pack labelling to help consumers interpret the information in the nutrition facts table. It is not a substitute but something in addition to the nutrition facts table.
Second, we urge the government to restrict advertising directed to children. There is growing momentum internationally to restrict food and beverage advertising to kids. Ireland, South Korea and the U.K. are a few such countries. We know that children are particularly susceptible to marketing and advertising, which is why, through the Chronic Disease Prevention Alliance of Canada, we support new restrictions on advertising.
Taxation of sugary drinks: Reducing the consumption of sugar can have a major impact on body weight. More than any other product, sugary drinks are directly connected to obesity and diet-related disease. The reality is that sugary drinks are in a class of their own. They offer virtually no health benefit or nutritional value. As is the case for tobacco, it's generally recognized that a price or tax increase is associated with decreased consumption of a particular product, which is what we want in this case. This could be done at point of purchase or at the manufacturer level.
Active transportation: In addition to helping to maintain a healthy body weight, we know that being physically active can help decrease, over your lifetime, your risk of certain types of cancer, specifically colon cancer and breast cancer. There are different ways to be active, but some studies have shown that the most effective way of increasing physical activity is to incorporate small changes into your day-to-day activities, usually through your commute to work or to school. Things like bike trails, sidewalks and parks can offer people a safer environment when they choose active transportation, and many activities in those settings can be relatively inexpensive, like running or biking.
The last option I would like to highlight — but it doesn't mean it's the last one or least important — is food insecurity. It's a critical public health issue in Canada. It's often as a result of low income and economic status and has a profound impact on how people buy and consume foods. Cheaper foods tend to be higher in calories, added sugars and fats, and lower in fibre and micronutrients. A growing body of evidence suggests that people who are food-insecure are more likely to be overweight and obese, and children from food-insecure families have a greater chance of being obese later in adulthood.
There are specific things that governments can do to subsidize healthy foods, increase availability and affordability, and incentivize healthy-food retailers to enter low-income areas, but governments can and must do more to address poverty, generally, in Canada.
Obesity is a complex issue, but we cannot allow the complexity to paralyze our response to the growing crisis. Sometimes we just have to try new things.
Thank you.
The Chair: Thank you very much. I guess it's probably no surprise to us that the three major groups represented here today have overlapping suggestions for us. We're looking forward to exploring those matters with you. I will open up the floor to questions from my colleagues.
Senator Eggleton: Thank you for your representations.
I want to start by talking about the food guide, because I understand there was some discussion about it at a recent Canadian obesity summit in Toronto, and there was a critical comment made at that time. The article in the Canadian Medical Association Journal says "Food guide under fire at obesity summit."
The food guide was first developed in 1992, and I understand it really hasn't changed all that much. There's some criticism that it's not evidence-based and that it needs to be changed to better serve the needs of Canadians. Can you comment on the food guide and what kinds of changes should be made to it?
The Chair: Mr. Arango, do you want to start?
Mr. Arango: It certainly needs an update; there's no doubt about it. I mentioned during my comments that the Brazilian food guide that came out about a year ago is an example of an approach to a food guide that a lot of people really respect. It says to eat whole foods, cook from scratch and avoid eating out. It talks about preventing or restricting marketing to kids, as well.
The other thing I would add about the food guide is that one issue the Heart and Stroke Foundation has with the food guide — and we have communicated this to officials — is that it basically equates consumption of fruits with fruit juice. For example, if you don't have access to fruit, et cetera, an alternative is to drink fruit juice.
The reality is that fruit juice is chock full of sugar. Sometimes it has 33 per cent more sugar than pop. A bottle of pop, for example, has 39 grams of sugar per serving. In some cases, fruit juices can have 58 grams of sugar per serving. Just because it's naturally occurring sugars versus added sugar makes no difference.
We do have some concerns about that, and we think Health Canada has been listening. We do hope they act on it.
Ms. Walker: I would say a lot has changed since 1992. Canadians are being bombarded every day by confusing health messages that are coming from different sources. It's up to us to start simplifying that message.
Right now, the food guide contains some very important information, but it exists in such a way that it is not the easiest thing to follow. The food guide can differ based on your age, gender and other things.
Looking at different messages — the "whole plate" concept looks at how you split up your plate. Usually about half of it should be vegetables and fruit. About a quarter should be grains, and another quarter is protein.
Finding a simpler message will be of huge value to Canadians who are struggling every day to try to make those decisions.
Dr. Hux: I'm not sure I have anything to add.
Senator Eggleton: Part of the criticism is that it also provides very technical measurements for portions and servings, but I think you addressed some of that.
Let me ask about the advertising, particularly toward children, of unhealthy foods and beverages. I think the Quebec model says that you can't advertise anything aimed at children. Where does that end — at age 13 or something like that? But then there are youth older than that who can still be influenced by this advertising.
Some jurisdictions — and even the voluntary arrangements that have been tried here — have tried to come up with criteria as to what is healthy and unhealthy. If Canada went with that model, what criteria could be developed or how would they be developed?
Ms. Walker: I think age is an important component, but I think most of my colleagues would agree that 12, 13 or 14 — there may not be a perfect answer to that one.
We would be looking at a comprehensive ban. Right now the Quebec model is particularly focused on television, but there's an increase in social media right now that kids are looking at, whether it's Twitter or Facebook, and a lot of ads are being pushed through other mechanisms. We would want to have something that is cross-border as much as possible and that targets a number of different media for advertising. Even some games nowadays have "Tony the Tiger" type ads that are based on food products. Trying to get all of those ads out is potentially challenging but also very important.
One of the things you alluded to is that Quebec bans advertising of anything to children, whether it's food or even toys. I think we've struggled as a community to decide whether it should be based on certain criteria for food. That gets into a tricky discussion of how easily we can categorize foods into healthy and unhealthy.
The community is starting to lean more toward banning all foods, without restricting educational campaigns that promote the consumption of vegetables, fruit and healthy products.
Senator Eggleton: Perhaps banning advertising on all foods and beverages geared toward children to what age? Would we go up to 18? Would we go up to the majority age?
Mr. Arango: As my colleague indicated, that's a bit of an issue for debate.
Senator Eggleton: I'm just trying to get your opinion.
Mr. Arango: Ideally, the higher you can go the better, but there are questions around the feasibility of implementation.
Kids are more susceptible when they are younger as opposed to older. If possible, we'd like to see it higher, but it might be more feasible to use 13 as the cutoff, which has been the standard in most countries that have adopted regulations. In the U.K., 16 years is the cutoff.
Senator Eggleton: All platforms, I think you're saying as well, not just television and broadcasting.
Mr. Arango: I would echo the comment of my colleague that a comprehensive ban on all marketing mediums is important. I'd also add that many groups prefer restrictions on commercial marketing of food and beverages versus all products, sort of the Quebec approach, which is good, but it does have some loopholes or some issues. For example, it prohibits the commercial marketing of tennis rackets and skates to kids, which don't have a negative impact on health — it's the opposite. So that's an issue.
The other issue is that the Quebec model focuses on restricting marketing directed to kids. That means that during children's programming, you are allowed to advertise products that are directed to adults; so McDonald's can advertise the Big Mac during children's programming.
Senator Eggleton: A loophole.
Mr. Arango: Yes, a loophole.
We prefer a ban on all commercial marketing of food and beverages to kids. That will work because 90 per cent of the foods and beverages that are advertised to kids are unhealthy.
Senator Eggleton: A couple of you have mentioned that food insecurity and obesity are strongly linked to low income. You've mentioned low income and poverty. Do you have any statistics on the effects of obesity at different income levels?
Dr. Hux: We know that diabetes, which is of course a direct consequence of obesity for people genetically at risk, is clustered in low-income communities. The rates in the most affluent counties will be half those of the least affluent counties, and food security is clearly part of that. There is that strong correlation.
We think of food security when we think of northern and more remote communities where fresh fruits may not even be present, but there are what we call food deserts even in large cities. In some areas of Toronto there is very poor access to fresh fruits and vegetables.
Senator Eggleton: I agree with you. If you've got any statistics, they'd be good to have. I'm trying to find a more evidence-based statistical analysis on income levels relative to obesity.
The Chair: Speaking of statistics, during one of your presentations you referred to the idea that childhood obesity tends to carry through life. We've heard that statistics show that by age 18 a certain percentage of youth are obese. The question is on the percentage of those where the natal situation gave rise to the likelihood of long-term obesity versus those who came to be obese through consumption or lifestyle, between the ages of 1 and 18. That's not a question but an interjection because it has arisen before.
Senator Seidman: Dr. Hux, at the end of 2014 you wrote an article that was published in The Globe and Mail, entitled "Blaming Diabetes on Poor Eating Habits has Delayed Real Action." I'm not sure if you remember what you wrote in that article because it was some time ago, but probably you do. You said at the end:
. . . the first step is to effectively confront the misconception that diabetes is exclusively the fault of those who eat too much and move too little.
Dr. Hux: I certainly would still endorse that position. There are three types of risk factors for diabetes. There's a genetic risk that is not modifiable, such as South Asian heritage, First Nations, or member of a family where 18 of your close relatives have Type 2 diabetes. That risk carries with you independent of your behaviours. Also, there are individual lifestyle choices that we've referred to, such as eating less and moving more.
The thing I wanted to highlight in that piece was the environmental factors — the fact that we live in an obesogenic environment and not all of our choices are as free as we'd like them to be.
I have a piece of evidence in that regard. Research done in small neighbourhoods in Toronto looking at the rate of diabetes developing over five years showed that if you live in the least walkable neighbourhoods of Toronto, your risk of developing diabetes is 30 per cent to 50 per cent higher than if you live in the most walkable neighbourhoods, after controlling for things like income and other health risk factors.
Anecdotally, like my colleague I struggle to maintain a healthy weight, despite having all the information and the affluence to own three pairs of good gym shoes and a portable gym membership. If I don't exercise, it is my fault.
But I think about an impoverished mother in a high-crime neighbourhood who cannot afford a babysitter, a gym membership or running shoes and is afraid to go out for a walk because she may be the victim of a drive-by shooting. If she doesn't exercise, her set of choices is far more constrained than mine. If we don't address those environmental issues and simply focus on blaming the individual for bad behaviour, then we miss a lot of opportunity to act.
Senator Seidman: You referred to Finland.
Dr. Hux: Yes.
Senator Seidman: You gave an example that you used to illustrate the point you were trying to make. Perhaps you could relate that to us.
Dr. Hux: In the 1960s, the Northern Karelia Province in Finland was found to have the highest rate of cardiovascular disease in middle-aged men in the world. They petitioned their government to take action on this. The government put together a multi-sectoral team, including representatives from the World Health Organization as well as the obvious players from community health and physicians. They really thought broadly about the impact, so they brought in the farmers, the food manufacturers and the food sales outlets. They brought everybody to the table and really started to shift the culture.
In terms of thinking about the systemic effects at the time, dairy farming was one of the major industries in the area. People would sit down with a pound of butter and slice it off like cheese. No wonder they had problems with coronary disease. So they created incentives to turn dairy farmers into berry farmers, berries having no fat and being highly healthy. They saw a 60 per cent to 80 per cent reduction in coronary disease in middle-aged men over the following 30 years, a dramatic public health success story.
Senator Seidman: That is dramatic. That leads me to my next question for all of you on evidence-based interventions.
Dr. Hux, you've related a couple of very effective evidence-based interventions. After telling us about the dreadful adverse health effects of obesity and giving us lots of ideas, the hope at the end of the study is to make recommendations that are actionable and can have some impact.
Could you give us an example of an intervention that has worked? When I say "worked," I mean there's evidence that it can be implemented successfully and evidence that it results in a change of any kind of behaviour related to obesity.
Mr. Arango: Do you want only one? I referred to a couple of them in my speech. I think a number of my colleagues did as well.
We know that marketing to kids is impactful. It has been shown to be very cost effective. In the U.K., when they implemented restrictions on marketing to kids on TV, the number of ads went down and the exposure of children to these ads went down. Unfortunately, it went up on other marketing mediums, such as the Internet, because it wasn't covered.
We know that if you try to restrict it in a certain area, it will work. We know that in Quebec, although there are some loopholes, there has been evidence that it has been effective. Among 2- to 11-year-olds, Quebec has the lowest obesity rates in Canada, one of the highest levels of fruit and vegetable consumption, and one of the lowest levels of junk food consumption and sugary drinks consumption. So something is definitely happening there. There is no doubt.
The other issue is related to taxation. We know that price is king. When it comes to tobacco, taxation was the single most important intervention that we implemented to reduce tobacco consumption. The same can happen with food. Obviously, tobacco is different from food. We need food to survive. However, in the case of something like sugary drinks, which have very little nutritional level and lots of risk, it can really work there.
In Mexico, a tax was implemented about a year and a half ago. A 10 per cent tax resulted in roughly a 10 per cent reduction in the consumption of sugary drinks and a 7 per cent increase in the consumption of beverages that were not taxed, so water and milk. There is definitely evidence on those two fronts across the world.
Senator Seidman: Dr. Hux, you referred to a successful program that guides healthy eating, the CDA Food Skills for Families Program in British Columbia.
Dr. Hux: We are training trainers to go into communities. It is a hands-on cooking experience where people learn to make economical meals from whole foods that are health-promoting, and it gives them other options than the fast food that they may gravitate toward.
Senator Seidman: Is that program evidence-based? Has it worked elsewhere and now is being implemented?
Dr. Hux: No. We are just in the beginning of the evaluation of it. Stay tuned for the results on that.
[Translation]
Senator Chaput: The three of you each represent an organization with a specific focus: heart disease and stroke, diabetes and cancer. Clearly, obesity is a major concern for the three of you because it has an adverse effect on what you are trying to achieve.
I believe you partly answered my question, which was asked by Senator Seidman. Nevertheless, I'm going to ask it differently. Your organization has developed strategies to prevent or reduce obesity. You gave some examples but can you give us examples of strategies specific to heart disease or diabetes, or do those strategies apply to all three illnesses?
Ms. Walker: Generally speaking, most strategies can be applied to all three diseases. As far as cancer is concerned, it's not a single disease, but the strategies are applicable to a number of different illnesses. Something I didn't mention and that isn't strictly related to obesity is the consumption of certain cancer-causing foods such as red meat and processed deli meats. Foods like those are tied specifically to cancer, or at least certain types of cancer, so we've put educational strategies and programs in place targeting those foods. But I think we would all agree that most of our strategies are mutually applicable. A single strategy can have the effect of reducing the risks associated with diabetes, heart disease and cancer.
Senator Chaput: Would you care to add anything?
[English]
Dr. Hux: I would say that we agree on more than we differ on. In the case of diabetes, there is the added advantage that once a person develops diabetes, their disease is much more easily controlled if they are living in a food environment that discourages obesity and a physical environment that promotes an active lifestyle. There is the benefit not only for prevention but also for management of the disease.
Mr. Arango: I would definitely agree that there is a lot of overlap.
One point, a nuance, a difference that I would mention, is that when it comes to reducing obesity compared to reducing general cardiovascular disease, in the case of obesity, nutrition is going to be a little more impactful and relevant compared to physical activity. But, generally speaking, when it comes to cardiovascular disease, they are both of equal importance. Physical activity can definitely mitigate the impact of obesity; however, nutrition is huge. It is very important.
We sometimes say that you cannot outrun the fork, which means that if you are over-consuming, it will be really tough through physical activity. That is not to say it is not important, because it is incredibly important, but as I mentioned in my speech, if you are consuming a 20-ounce can of pop or fruit juice, you will have to run for 50 minutes or walk 5 miles to offset that, if you are an adolescent.
[Translation]
Senator Chaput: What is the main factor that has contributed to the increase in obesity in Canada? Is there a leading factor?
Ms. Walker: The fact that society has changed so much over the past 50 years plays a role, in my view. More emphasis is placed on the easier option. And as a result, our food choices are based on meal preparation time. We drive to work in order to save time. Our reality and environment have changed tremendously over the past half-century, and that has significantly influenced obesity rates. The foods we eat, processed foods, are usually very high in salt and sugar. On the upside, those ingredients preserve foods on store shelves longer, but the downside is that they have a negative effect on our food consumption.
[English]
Mr. Arango: Processed food consumption, as I mentioned, the increase is definitely related to it, from 29 per cent to 62 per cent over the last number of decades.
Sugary drink consumption is a huge factor as well. In the United States and Mexico, they have one of the highest rates of obesity in the world, and they also have the highest rates of sugary drink consumption.
Our approach in terms of the way we live our lives is that we are much more sedentary and much more into convenience, including processed foods. That has all had an impact.
Senator Enverga: Thank you for your presentations.
We are hearing a lot about a healthy diet and the food guide, but do we have enough information about this? Have we created enough awareness amongst the population? Have we created enough education? Do we need something like more warning signs? What have we done so far that you think is effective?
Dr. Hux: There may be more information, but there may not be more understanding. My colleagues referred to the nutrition facts table, which is rich with information, but it does not necessarily lead to wiser food choices. Some of that is an education issue around helping people to understand and interpret labels, which is why our Food Skills for Families Program includes label interpretation. But I think it requires looking again at those labels, and probably a quick front-of-package, simple-symbol system would help people understand and appreciate.
I also think it requires developing in people the skills to make healthy foods easy and fast. People may gravitate toward a packaged solution because they think that is faster. Recipes and cooking approaches that can make a healthy, rapid meal would be helpful.
For sure, more information is needed, and more communication of information. We are drowning in data and sadly lacking in wisdom when it comes to our food choices.
Senator Enverga: It is hard to imagine what kind of labelling that would be. I want to ask you about the labelling process that we have talked about here. If it is really going to make you obese, could we add labelling such as the picture of an elephant, and then the picture of a pig if it's a little bit better for you, and then the picture of a mouse if it is healthier? Do you think that would be helpful?
Mr. Arango: In the case of tobacco, warning labels have been effective if they are graphic, definitely. At the same time, we don't want to "blame the victim."
If someone, as Dr. Hux indicated, is living in an impoverished environment, single mom, low income, four kids, we don't want to implement a warning label that will blame that person or individual for the circumstances they live in that are beyond their control. We have to be careful.
The notion of warning labels, generally speaking, has been raised. I think a bill introduced in California recently related to sugary drinks that did not quite pass, but that is something that would be part of a multi-pronged approached using warning labels.
Senator Enverga: I know there are some well-to-do neighbourhoods and then poorer areas. Do you think we should be selective with the way we present the food guide or the labelling? Do you think it is possible? Would you suggest that we differentiate between different neighbourhoods? If there are poor people, then we don't use the graphic pictures, but where for a wealthier area, we use the label. Let's put the elephant or the pig or the mouse over there. Do you think we can separate the two?
Ms. Walker: When you are looking low income, you often have a situation that is also low education. Those things usually go hand in hand. So making warnings, whether it is an elephant or a pig, is making it easy to understand. But making something simple — a green, yellow or red light — that will help people who don't have the same level of education to interpret that information is really key. We probably need to put those in all neighbourhoods. I think everyone would benefit from them, but keeping in mind plain language and an easy to understand approach will be key.
Right now, as my colleague said, there is information. I can look at a package and do the mental math. When I compare two yogurts, which is the biggest beef in my grocery shopping every time, I have to compare. Is the serving size for this one three quarters of a cup or is it half a cup?
I see heads nodding. We are all struggling with yogurt.
Then I am forced to do fractions to see which one is the best for me to have. I am then looking at sugar content and fat content. It is not easy to understand. It would be nice to have a single source of information.
Retailers right now have different ways of indicating the red light program or the stars in Loblaws. Having so many different kinds of labels adds to the confusion. Having one simple, government-endorsed system will help take away some of that difficulty.
Dr. Hux: I would add that most of those concerns apply to packaged foods. I think another major message we want to communicate is to stay out of the aisles. When you go to the grocery store, shop around the edge. It is the avoidance of package foods rather than demonizing a particular type of packaged food that may be an important step forward.
Senator Enverga: With regard to packaging and labelling, oftentimes it is hard and tedious to read each label on the package. Would you advise that we require all the supermarkets to put a big label out there saying this is a red light or a green light food?
I have been to many pet stores and have seen fish labels that say red is too vicious; they'll kill each other. With yellow you can put them together, and the green ones you can mix together. Maybe we can do the same for food: "You can eat more of this"; the yellow ones could say, "Be careful"; and for red, "Eat only one of these." Is that possible?
Dr. Hux: I certainly think something that simplifies things is important. That is not a matter of education. I think those of us who are more affluent sometimes feel more time strapped and want something quick, and we don't need to be perusing the back of the package. So yes, something that simplifies it and cues the appropriate decision would be helpful.
Mr. Arango: A study came out recently that compared three different systems. One was a traffic light system — red, green, yellow lights — then a scale of 0 to 150, and then a simple logo, one simple symbol. They found that the use of the simple symbol was the easiest for consumers to understand.
Regardless, at the end of the day, I think your comment is extremely valid. We need a simple symbol-type system implemented in stores and restaurants to help us with healthy eating.
The Chair: Mr. Arango, would you send that report or a reference to it to the clerk, please?
Mr. Arango: Yes, absolutely.
Ms. Walker: I am struggling to remember the country that did this, but it has also been shown that when prepackaged foods are labelled, it also forces the manufacturer to rethink how they are manufacturing their food and what is going into the food. I think it was the U.K. that showed retailers were starting to reformulate their food. It does have a longer term impact into how the food supply system works in that particular country.
Senator Raine: We appreciate your expertise in these areas. We all know that it is not going to be easy to make changes.
What do you think is the role of our education system in this? Over the last 40 years, things have changed in the education system. We have decreased physical education and increased computers, et cetera. What do you think schools should be doing to educate the children coming through so they can make good food choices?
Mr. Arango: Clearly, awareness and education in schools is important. It will not only help perhaps with children making better choices but in the end, as they become adults, it will enable them to understand that other things have to be done to address nutrition or physical activity, et cetera, so they will be more accepting of government interventions or programs to address either nutrition or physical activity.
The other thing that is very important for schools to do is not just educate by saying, "You should eat this." They have to practise what they preach. We cannot communicate to kids that they should not drink sugary drinks, should drink milk and water, avoid hamburgers and try to eat fruits and vegetables, when in the cafeteria all they have is sugary drinks and processed food for sale, and very little fruits, vegetables, milk or water available.
It is changing in Canada. The food environment in schools and cafeterias is slowly changing, and it's very important that schools not just educate but practise what they preach and offer healthy options to kids.
Senator Raine: Do you think there should be zoning around schools to prevent food outlets nearby?
Mr. Arango: Absolutely. If you improve the food environment in the school cafeteria and the environment near their school is not ideal, then the kids will gravitate to the "near school" environment and go to the fast food outlet. It is important to ensure that there are not food swamps and avoid food deserts around schools and in low-income neighbourhoods as well.
Ms. Walker: There are two things I would add to that. First, when we are talking about a multi-pronged approach, is it is not just from the federal government. We are talking about things that can be done in a community setting, in schools and by employers, not-for-profit groups, everyone. The school environment is important in teaching kids and not normalizing certain behaviours, as Mr. Arango said.
One of the things that stuck with me is the recycling experience from many years ago. That was started in a school setting. Kids would go home at the end of the day and say, "Mom and dad, you have to put that in your recycling." That has been a huge success story. Having kids learning that early on means that oftentimes they can come home and say, "Maybe we shouldn't be eating that," or "There is too much red on my plate and there should be more green." That is a unique environment in addition to other things we should be doing at a policy level.
Dr. Hux: You mentioned physical activity. Certainly the diminution of meaningful physical activity in the curriculum is doubtless one of the contributors to the obesity epidemic in children. Curriculum is important, but as my colleagues have indicated, the environment is important.
There was a German study published in 2009 dealing with elementary schools where children were either both provided with water and water consumption was promoted, and they were compared to schools where that program did not exist. There was a 31 per cent reduction in the development of obesity over a one-year period.
Senator Raine: At the federal level, we are not responsible for the delivery of education or health. What are your organizations doing to monitor who is doing what out there at the provincial level in the education systems? Do you have any way of reporting what is happening and trying to educate the different jurisdictions as to best practices?
Dr. Hux: We do have a program for kids in school related to diabetes. The main focus of that is for children with Type 1 diabetes, which as you probably know is not associated with obesity. It is focused on where there are significant challenges in terms of monitoring blood sugar levels, getting injections and being able to have a snack.
A piece of that is the "foodscape" in the schools. We are advocating at the provincial level for enhanced policies. Again, that gets passed down to the school boards. The school boards, ultimately, would some decision-making authority. So we are advocating at the provincial level for the provinces to set standards around the expectations on school boards for healthy environments for children with diabetes.
Senator Raine: Does anyone else want to comment on that?
Mr. Arango: At the Heart and Stroke Foundation of Canada, we work at all levels of government; it is important at the municipal, provincial and federal level. I absolutely concur that we have to work at all levels.
Senator Raine: It strikes me that we have an education system — well, we have ten plus three, I suppose. So we have systems, but some of the expertise at the national level in your areas is maybe not reaching into those systems.
Mr. Arango: We do try to reach into the provincial education systems, but they differ across provinces. Sometimes we are perhaps not as successful in ensuring that the message gets there in every instance.
But we do realize that schools and the education system are great opportunities to influence kids and to ensure that healthy lifestyle patterns can go into adulthood. So we do try, but it is not always easy.
Ms. Walker: One of the things that worries us as health groups, generally — and I will not speak for my colleagues — when we are looking at the provincial and federal jurisdictions, the delivery is done provincially, but we want to be careful of not creating a patchwork across the country where some kids are getting access to some things and other kids are not. Some of the policies we have talked about — that is why we are talking about them at the federal level. There is a role for the federal government to play in some of these public health policies.
Tobacco has been a huge success because of the federal policy. The age to purchase tobacco can differ by province, but the federal government has put in a standard: It is 18 years old at the federal level. Provinces can increase that to 19 or 20, but the baseline has been established. A lot of the things we are talking about today would be along those lines.
Senator Raine: That is a good way of putting it. There have been federal-provincial-territorial conferences to discuss all this. Everyone is on the same page, but how do we get there? It is a challenge.
Mr. Arango: It is.
Senator Raine: When you talk about sugary soft drinks and their impacts, has a study been done on what happens if we flip over and they are all diet drinks and the different kinds of artificial sweeteners? If people move away from sugar, which apart from calories is relatively benign, to artificially sweetened drinks, do we know what the impacts of that will be? Do we know what will happen?
Mr. Arango: It would have been good if you could have been at the Canadian Obesity Summit a couple of weeks ago. We moderated a panel on the role of diet drinks as a harm-reduction tool to reduce consumption of sugary drinks. We had a couple panelists, one from Harvard and one from the U.K. One was arguing pro-diet drinks; the other said to be cautious.
The conclusion that came out of the panel was that, potentially, diet drinks are better than sugary drinks in many cases. However, the concern is this: Will people end up drinking both diet drinks and sugary drinks? Will there be dual use?
The other concern is that if you promote diet drinks, will you end up promoting continuing social habituation to sweet-tasting products? That is a concern.
At the end of the day, if implemented properly, diet drinks probably could be useful in terms of reducing consumption of sugary drinks, but it cannot be the end goal. We don't want to continue to promote sugar craving at a societal level.
Dr. Hux: The use of artificially sweetened beverages does continue to reinforce the craving for sweet foods. In fact, often they are sweetened to a level that feels sweeter than a sugar-sweetened beverage, so it could actually induce more cravings.
Another problem with them is the bad math we do in our heads. "Because I am having diet drink X, I can have that piece of apple pie and ice cream," when there are three times more calories and a lot more fat in the pie than if that person had had a regular soft drink. That type of bad mental arithmetic where we lie to ourselves is thought to be a behavioural problem with the artificially sweetened beverages.
There is some emerging evidence that there may even be a physiological effect and that it may alter the way our bodies handle sugars in a way that actually harms our metabolism. Certainly they are not the panacea.
Senator Raine: I suppose when it comes to marketing, if it is "diet" in our marketing, it is still —
Mr. Arango: You are right.
Senator Raine: In terms of marketing to kids, for instance, you shouldn't replace sugar drinks with diet drinks.
Mr. Arango: No, we wouldn't recommend the consumption of diet drinks to kids.
You are right: You can get that brand extension if you allow marketing of diet drinks. For instance, you would still have the Coke brand being promoted, and that is a problem.
Senator Raine: If I could make a statement, I really think the soft drink industry has to be part of the solution, because we all need to eat and we all need to drink. We just want to have healthy things to do it. They can fight over the share of the healthy things in terms of marketing, but we need them to be part of the solution.
Ms. Walker: You speak to something interesting. It comes back to the reformulation of foods. The more we create that environment, it will eventually create a demand for healthier products. In the meantime and until that day happens, some of the policies we are talking about will be key to changing people's perceptions and understanding. They will eventually, hopefully, lead to having food manufacturers create products that are generally healthier.
Senator Nancy Ruth: I want to raise the issue of cooking. Although Dr. Hux mentioned a program in British Columbia, I don't know how to cook. I do know how to make salad dressing, so I don't buy it bottled. But many of the people I know, besides all of the factors of time and efficiency, buy prepared foods because they don't know how to cook. Where does teaching people how to cook come into the equation for all three of you?
Ms. Walker: I think that speaks to the society that we have developed over time. We have moved from preparing foods at home and having a social experience with your family remembers to having something that is more convenient. All three of our associations, from a programmatic side, offer things like recipes, information and tips for people who don't know how to cook foods.
We also participate in marketing campaigns. One that the Heart and Stroke Foundation of Canada and Canadian Cancer Society have been a part of is with the Canadian Produce Marketing Association. It's called Half Your Plate, and it's meant to give a simple message to Canadians that half their plate should be vegetables or fruits. It provides information on how to look at new fruits and vegetables in a grocery store, which can be intimidating.
Senator Nancy Ruth: I will stop you there, because I know you all produce cook books, too. But if you are talking about kids and sugar, and the environmental campaign and how that happened from schools to home, how would you do that with cooking?
Ms. Walker: I'm not necessarily speaking for the Canadian Cancer Society here, but I would probably like to see more cooking in schools. That's a life skill, just as is physical activity. These are life skills. I don't want to compare it to trigonometry, which has had limited value in my professional life, but foods are still an important component of how you're going to grow up as an adult.
Mr. Arango: I would add that in some provinces, home economics was removed from the curriculum, and that's a problem. We need to reintroduce food preparation skills in schools. In particular, with respect to fruits and vegetables, food preparation skills are more important than almost anything else. It's really crucial because fruits and vegetables are not as easy to prepare as other foods. Food preparation skills are much more important in that case.
The Chair: Yes. I was surprised when you were talking about the education part that you didn't move further into the idea of incorporating back into the school system the preparations of food and involving children. We had a previous witness who discussed this as well. In fact, that witness used calculus instead of trigonometry, but the point was the same. In terms of life-long impact, that's where it stands.
I thought Senator Nancy Ruth's question was critical in the sense that the example she used is not isolated. It is significant in today's society; yet for some reason, the geniuses that deal with curriculum have managed to turn students off schools in droves by eliminating some of the basic aspects they need most for survival in life, and food preparation is one of those.
Senator Eggleton: We've heard some rather unexpected or maybe even contradictory statements before our committee hearings on obesity. I want to run over a couple of them that the researchers have prepared.
This committee has heard that the association between body fat and heart disease may not be as clear as traditionally thought. Witnesses have suggested that although overweight individuals may have a higher incidence of heart problems, recovery after a heart attack may be improved for those who are overweight.
As well, testimony has included the observation that overweight people who eat healthy and get modest exercise can be just as healthy as their healthy-weight counterparts. They are referring to overweight people.
In addition, while reports in recent years have linked a high-salt diet to increased levels of high blood pressure and cardiovascular disease, we've been told that salt consumption is considerably lower in recent decades due to improved food preservation methods.
One more point: We heard from James DiNicolantonio, a cardiovascular research scientist, who questioned the benefits of eliminating saturated fats and increasing unsaturated fats in the diet. Both he and Ms. Nina Teicholz, author of The Big Fat Surprise — and she's scheduled to appear here — asserted that there's no evidence to support the claim that diets should be low in saturated fats.
Do you have any thoughts about all those things?
Mr. Arango: A few years ago we moderated a panel at the Canadian Obesity Summit that looked at the first issue you spoke about. Do physical activity and other factors mitigate the impact of obesity? Absolutely. Physical activity can mitigate the impact. However, if you are morbidly obese, obesity will still have an independent impact on your health. Both things come into play. For sure, if you are eating properly and are active, it's going to minimize the impact to some extent. Like I said, if you have very high levels of obesity, it will still have an impact.
With respect to sodium, we've learned a lot in the last few years in terms of what levels of sodium consumption have an impact on health. However, there's still enough evidence out there that indicates that sodium consumption at high levels can have an impact on cardiovascular disease, hypertension, et cetera.
Saturated fat is being discussed in the media quite a bit. There are some suggestions, and we actually have a panel looking at this issue right now. There are suggestions that perhaps the existing evidence has been over-interpreted or not interpreted properly. We'll come out with a position statement on that issue in September. We hope to say something more firm on that particular issue. However, at the end of the day, there's still enough evidence to indicate that saturated fats have an impact, but perhaps not as much as we might have thought.
The last issue that I would raise relates to a documentary. You mentioned low-fat, high-fat intake. A documentary just came out called Sugar Coated. I think there's going to be a screening of it on May 21 in Ottawa. It happened in Toronto a few weeks ago. The documentary indicates that in the early 1970s when there was emerging evidence about sugar, the sugar industry got certain academics to say that fat was more of an issue than sugar so they could move the debate away from sugar intake to fat intake. There is a concern that perhaps the focus only on low fat has not been ideal.
Dr. Hux: You mentioned four, and Mr. Arango spoke to three of them. I want to speak to the other one, which is that overweight people who eat healthy and exercise can be as healthy as their less obese counterparts. That raises an excellent point that I neglected to mention in my remarks. In terms of the risk of diabetes, the reduction of obesity for an individual can be quite modest yet very impactful. The diabetes prevention program was a large, rigorously conducted randomized trial that took people who were at high risk of diabetes because of their obesity and put them through a program to improve their eating habits and to increase their physical activity level. It showed there was a 60 per cent reduction in the risk of diabetes, but that wasn't because they lost 100 pounds and got back to their weight in Grade 12. Actually, on average they lost between 5 per cent and 10 per cent of their body weight. A 200-pound person could lose between 10 and 15 pounds and, with that modest weight loss, could have a 60 per cent reduction in their risk of diabetes. Obesity for someone who weighs 250 to280 pounds can seem so daunting, yet the results of that study showed that by improvements in diet and an increase in physical activity, they can lead healthy lives as well.
The Chair: Let me just pick on how you put that. When you summarized, you said it showed that a 10 per cent to 15 per cent drop in weight led to the reduction in diabetes. There was another significant component of that, the exercise part.
Dr. Hux: You're right, we don't know which of the components, and that's the problem with a kitchen-sink study. When you throw the whole kitchen sink at a problem, you don't know which component really stuck to the wall. In this case, they had both improvements in their diet and increases in physical activity. Those changes in diet and physical activity led to a modest loss of weight but a dramatic reduction in the risk of diabetes. Whether it was the diet or the physical activity is not clear.
The Chair: But you must have statistics on people who have lost weight and its impact on diabetes. Traditionally, that has been the thing that people go to first — a diet that lowers their weight, et cetera. Do you have any statistics on weight loss alone and its impact on diabetes?
Dr. Hux: I don't. We find that for many people who are on my side of middle age, achieving weight loss by diet alone is very difficult. Often, enhanced physical activity needs to be part of that equation. But I'm sure there are studies —
The Chair: My point is that people go through the diet cycle. There are lots of people involved in dieting regardless of their age. The question is: Is there any evidence that losing 15 or 20 pounds has an impact on the diabetic character of the individual?
Dr. Hux: If there is, I don't know it. I'm sorry.
The Chair: Thank you very much.
Senator Raine: For the screening of Sugar Coated, none of us are going to be in Ottawa at that time because it's a break week. Can we get a copy of that documentary?
Mr. Arango: I'll ask the producers. I can't speak on behalf of the producers, but I can definitely get back to you on that.
The Chair: Do you know where the screening will be held?
Mr. Arango: It will be at the Mayfair theatre on Bank Street. I believe it will be at 6:30 p.m. on Thursday, May 21.
The Chair: Thank you very much.
Well, we have had another day of discussing some very interesting aspects of life and health around the issue of obesity. There are a couple of things I wanted to pick up on.
First, I've made this comment in other cases where the issue of labelling has come up and the requirements that packages show what's in the package and how much. I agree absolutely with the implied outcome of the comments you made with regard to looking at it and trying to figure out what it really bloody means. It's my opinion that if we think that stuff is going to make a big change in a harried shopper going through a grocery store and being able to decide on the fly what it is, even for a person who is interesting in knowing, I think we're delusional. I'm not suggesting that information shouldn't be there, but if we think that's going to make a huge impact on the way in which people carry out their lives related to their overall diet, I think that we're mistaken.
Let me repeat, however, that I'm totally in favour of that detail being on all the packaging. I'm absolutely in favour of that. I'm referring solely to the way a shopper incorporates that in a reasonable basis, a parent with two children tugging at the cart, going through the grocery store. As you showed with your two yogurt containers, it's not going to happen, in my opinion. It's exactly the same as we learned, those of us who have to give presentations, trying to teach students how to give proper presentations, that you don't put a thousand pieces of data on a single slide and expect the person in the audience who may be interested to go through all those pieces of data. On the issue of labelling, in some way we have to find an additional hook. I have not yet been convinced of the elephant model, but it keeps coming up for some reason.
I do want to come to another aspect. Ms. Walker, a couple of times you mentioned the example of the plate, showing half here and a quarter there. I bring this up as a response to that in a number of meetings. The question is this: Are there any examples out there that are simple and direct?
I saw an article on Argentina in which they have the issue of dealing with varying degrees of literacy in the country and wanting to do something very constructive with regard to giving guidance for proper meals. I'll take the breakfast example. The one I saw had five plates and showed five different breakfasts that would constitute those most likely to be of most interest to, I assume, Argentinians. It was very direct and very clear in terms of what it conveyed. These were all within the overall caloric and other issues that they considered to be important with regard to the guide. That's a very simple thing to be able to do. I won't go beyond that at the moment.
The other thing that I wanted to pick up on, and you dealt with this, Mr. Arango, is the change in how we operate. The opportunity for exercise is diminished greatly, simply by the way we deal with things. We've heard a fair amount of testimony with regard to that issue. If you simply look at a modern suburb, it has no sidewalks. Even if you wanted to go out after supper and go for a walk, you're fighting traffic or snow and all those kinds of things. That gets us to the idea that since this is a complex issue, we're going to have to have more than just simple solutions as we go forward. Impacting how we develop the physical social infrastructure as well as the food guidance may turn out to be important.
On the issue of advertising, clearly the evidence from the past has been clear, but as two of you said, in today's world, children are influenced increasingly to a greater extent by the non-traditional advertising issues, and they are alive in those worlds. Controlling that will be interesting. I would like to see the recommendations that suggest how you control all of that. If we simply take the difficulty parents have dealing with pornography on their children's machines, the issue of indications of food advertisement and so on is going to be an interesting phenomenon.
I guess what I'm really saying to you is that you have certainly agreed with the testimony we've had and added to it in terms of examples and so on. It's an issue. We've got a serious issue. There are a number of ways of looking at it, and we need to come up with recommendations that can be acted on. We can speak about the long-term issues that society has to grapple with, but we'd also like to be able to come up with recommendations that actually can be meaningful in the short term as we move through the medium term to the long-term solution of a very complex issue.
I'd like to ask you, after you leave here and you think about the discussions we've had examples, if something comes to mind, would you just jot it down and send it to the clerk and give us an idea there?
One of the things that didn't come up today — I didn't expect it to — is that recently there has been a study out of Scandinavia with regard to the scholastic success of obese children relative to non-obese, and it's startling. The reduction in achievement and the failure to complete high school is dramatic in the study that has been released. This issue is a very serious one for the ongoing health of society overall. After you leave, if something occurs to you at any time, please get that suggestion to us through the clerk. I can assure you we're paying attention to everything that comes to us in that regard.
On that note, I want to thank you very much for the way in which you have answered the questions. The examples you have given are tremendously clear in terms of what you intended them to convey to us, and I think you've answered all the questions our committee has put forward.
(The committee adjourned.)