Health Committee on Feb. 3rd, 2011

[The Chair, Conservative, Joy Smith]

Good afternoon, everybody. It's so nice to see you here today. Welcome.

Before I start, I want to welcome Madame Josée Beaudin to our committee officially. I understand you're a new member. We're so pleased to have you here.

Of course, Tilly O'Neill-Gordon, it's a delight to have you here officially.

We also have a couple of other people, Ms. Sgro and Mr. Calandra, who are so graciously filling in for some others who cannot make it right now.

Today, pursuant to Standing Order 108(2), we have our study on healthy living. We're very pleased today to have a myriad of different people to give us some very insightful comments and information.

We have, from the Canadian Diabetes Association, Glen Doucet, vice-president, office of public policy and government relations; and Aileen Leo, associate director, office of public policy and government relations. Welcome, both of you.

We also have, from the Canadian Sugar Institute, Sandra Marsden, president; and Nancy Gavin, manager, brand development, Redpath Sugar Ltd. Welcome.

From the Centre for Science in the Public Interest, we have Bill Jeffery, the national coordinator. We welcome you.

From the Québec Coalition on Weight-Related Problems, we have Suzie Pellerin, director, and Marion Saucet, analyst-researcher. Thank you so much.

From the University of Saskatchewan, we have Dr. Barbara von Tigerstrom, associate professor from the college of law. Welcome.

We certainly have a very prestigious and informative group here.

Glen Doucet from the Canadian Diabetes Association, I think I'll start with you. Are you ready to go?

You each have five minutes for presentations.

Thank you.

[Aileen Leo, Associate Director, Public Policy and Government Relations, Canadian Diabetes Association]

Good afternoon. I'll be making the presentation on behalf of the association.

[The Chair, Conservative, Joy Smith]

Oh, okay. That's fine.

[Glen Doucet, Vice-President, Public Policy and Government Relations, Canadian Diabetes Association]

I'm just here for good luck.

[Voices]

Oh, oh!

[The Chair, Conservative, Joy Smith]

I stand to be corrected.

[Glen Doucet, Vice-President, Public Policy and Government Relations, Canadian Diabetes Association]

Please go ahead. Thank you.

[Aileen Leo]

Thank you very much.

The Canadian Diabetes Association appreciates the opportunity to appear before the standing committee in your study on healthy living. We wish we had better news about the fight against diabetes; however, that's not the case.

In 2009, the Canadian Diabetes Association released An Economic Tsunami: The Cost of Diabetes in Canada, a report that outlined the estimated current and projected prevalence and cost of diabetes in Canada based on the Canadian diabetes cost model.

The findings of this model are indeed shocking. Today, more than three million Canadians are living with diabetes. Diabetes prevalence in Canada has almost doubled over the past decade and will continue to rise over the next decade.

No region of Canada is immune to diabetes. Atlantic Canada bears the greatest burden. Newfoundland and Labrador's prevalence is over 9% today and will rise to over 14% by 2020. In Alberta and British Columbia, where diabetes rates are below the national average, prevalence will grow by 67% and 62% respectively; the highest growth rate in Canada.

In Atlantic Canada, over 30% of the population will have diabetes or pre-diabetes by 2020. Pre-diabetes exists when blood glucose levels are higher than normal, but not yet high enough to be diagnosed as type 2 diabetes. Over 50% of the people living with pre-diabetes will develop diabetes.

The impact of diabetes on our health care system and our economy are equally staggering. The cost of diabetes in Canada currently stands at $12.2 billion annually and is estimated to grow to almost $17 billion annually by the end of this decade. By 2020, the economic impact of diabetes in Canada will have increased by over 130% from the year 2000. So it is clear: Canada has a diabetes epidemic, which is getting worse.

Our diabetes cost model shows that 80% of diabetes-related costs are due to treating the serious complications associated with diabetes, not for treatment and management of diabetes itself. These complications include kidney failure, heart attack, and stroke. Therefore, to address the economic impact of diabetes, we need to focus on keeping those living with diabetes healthy to avoid or at least delay these complications.

Our brief to the committee contains three recommendations, calling upon the federal government to enhance support for a pan-Canadian healthy weights strategy; a comprehensive secondary prevention strategy for people with diabetes and pre-diabetes; and thirdly, potential regulatory changes to promote healthy eating and physical activity.

For today's presentation we will focus our remarks on our first recommendation of a pan-Canadian healthy weights strategy.

According to Statistics Canada, 61% of Canadians are either overweight or obese. Among children and youth, more than 17% are overweight and 9% are obese.

The link between excess weight and type 2 diabetes is clear, given that 80% to 90% of the people with type 2 diabetes are either overweight or obese. While obese persons have the highest individual diabetes risk, it is those who are overweight who will drive the largest increase in diabetes prevalence rates over the next decade.

So while a focus on obesity is certainly important, it is clearly not sufficient. If we are to combat this diabetes epidemic, we also need to focus on Canadians who are overweight but not obese.

More than 50% of cases of type 2 diabetes could be prevented or delayed with healthier eating and increased activity. Even a moderate weight loss of 5% to 10% can significantly reduce the risk of developing diabetes.

For those living with diabetes, maintaining a health weight is the best defence for preventing serious, life-threatening complications. For those living with pre-diabetes, achieving a healthy weight not only reduces their likelihood of developing diabetes but may also result in their blood glucose levels returning to normal.

Given the costs associated with diabetes complications, investing in a pan-Canadian healthy weights strategy makes sense in terms of better health outcomes for those Canadians with diabetes as well as making good economic sense. Therefore, we urge the federal government, in partnership with provincial and territorial governments, to move forward in their framework to promote healthy weights. But we must also ensure that this framework includes those Canadians who are overweight in addition to those Canadians who are obese.

A pan-Canadian healthy weights strategy would increase the percentage of Canadians at a healthy weight through five main goals: identifying and understanding the underlying societal causes of unhealthy weights; setting targets to increase the number of Canadians achieving healthy weights, specifically within high-risk populations; improving access to programs and services for high-risk populations; initiating a public education campaign across all sectors of society; and incorporating a multisectoral approach involving governments, non-governmental organizations, the private sector, and all Canadians as individuals.

[The Chair, Conservative, Joy Smith]

Excuse me, Ms. Leo, could you wrap up shortly? I've given you extra time.

[Aileen Leo]

Yes. I have just one more paragraph. Thank you.

Increasing the percentage of Canadians achieving a healthy weight will not be easy. In fact, it will require widespread personal and societal change as well as significant shifts in the approach by governments and the private sector.

Thank you very much.

[The Chair, Conservative, Joy Smith]

Thank you very much, Ms. Leo.

We'll now go to the Canadian Sugar Institute. Who would like to present? Is it Ms. Gavin or Ms. Marsden?

Ms. Marsden, go ahead.

[Sandra Marsden, President, Canadian Sugar Institute]

Madam Chair, members of the committee, thank you very much for the opportunity to be here today.

The Canadian Sugar Institute is the national, non-profit association representing sugar manufacturers in Canada on nutrition and international trade affairs. The institute provides a science-based nutrition information service that is staffed by professional dietitians—in fact, I'm a registered dietitian—and a nutrition scientist. We are also guided by a scientific advisory council and work collaboratively with professional and voluntary health associations, such as the Canadian Diabetes Association, Dietitians of Canada, and others. Most importantly, the institute does not market or advertise sugar.

My remarks today will focus on two issues relevant to the committee's study: government promotion of healthy eating and food labelling. All of our communications at the institute are science-based, and most often we are addressing misinformation. We have commissioned consumer studies since 1985, which have shown that consumer understanding is not consistent with science. For example, only 30% of Canadians understand that sugar has half the calories of fat. Like all carbohydrates, it has four calories per gram. Among Canadians, the median estimate of the number of calories in a teaspoon of sugar is 67. The correct answer is 16.

Let me give you a very brief background on the science of sugar. Sugar is the common name for sucrose. Sugar is produced naturally through photosynthesis in all green plants, including all fruits and vegetables. The pure sucrose crystals, sugar crystals, are separated from sugar cane and sugar beet to meet the Canadian food standard, which is 99.8% sucrose. I think that's probably enough science.

Sugar consumption in Canada has been declining, mostly due to the substitution of high-fructose corn syrup in sweetened beverages and some food products.

The Canadian Sugar Institute supports government strategies that are positive and enabling, not negative or targeted at individual foods. We support government frameworks such as the pan-Canadian healthy living strategy to promote healthy weights and those that build on a foundation of science and positive guidance, including Canada's Food Guide and physical activity guidelines. We do not support short-term, costly initiatives that target individual foods, such as the recent Government of Canada ad stating that sugar-sweetened drinks are linked to childhood obesity. Obviously this is of concern to our industry, because in fact the vast majority of sweetened drinks in Canada do not contain sugar; they are sweetened with high-fructose corn syrup. However, this messaging also implies a relationship between an individual food and its alleged ingredient—sugar—and obesity, which is not supported by the evidence. Scientific studies consistently find an inverse relationship between sugar consumption and being overweight, likely because low-sugar diets tend to be higher in fat. Fat has nine calories per gram, relative to carbohydrates at four calories per gram. Negative and inaccurate messaging about the ingredient sugar is not assisting consumers in making healthy choices.

We would like to draw your attention to the issue of food labelling and the ingredient list. This issue is very important to consumer decision-making in food choices. The Canadian Council of Food and Nutrition, in its “Tracking Nutrition Trends” report of 2008, which was a report giving a 20-year history, stated that when reading food labels, 80% of Canadians identify the ingredient list as the most important source of information. The ingredient list on food labels, as you probably know, must list all ingredients in descending order by weight. The common name must be used if it is prescribed in regulation. For sugar, that means 99.8% sucrose. Otherwise, it must use the common name of the food as it would be known in the marketplace.

We have had an increasing number of consumer inquiries regarding the labelling of high-fructose corn syrup in foods in Canada. Consumers are confused. There are two reasons for this. First, in Canada, high-fructose corn syrup is labelled as “glucose-fructose”, a term Canadians do not understand. Secondly, there is a collective term, “sugar/glucose-fructose”, which is permitted when either or both of the ingredients are used. All other sweetening agents must be labelled separately. This confusion may arise because the U.S. label uses the common term “high-fructose corn syrup”, as it is known to consumers, health professionals, and the media. Sugar and high-fructose corn syrup are not the same ingredient. High-fructose corn syrup is a sweetening agent made from cornstarch.

We feel the ingredient labelling of glucose-fructose in Canada is confusing and misleading to consumers.

I'd like to end by telling you a little bit about a survey that we conducted. We were interested in knowing how confusing the labelling was. First, we did an informal survey of dietitians. Only 12% of dietitians stated that glucose-fructose referred to the ingredient, high-fructose corn syrup. Given this poor level of understanding among dietitians, we decided to seek a nationwide online survey.

An Ipsos Reid poll conducted between January 28 and 31, 2011, found that when presented with a list of ingredients, including glucose-fructose, just one-quarter of Canadians correctly identified that as high-fructose corn syrup.

When given an ingredient list with the collective term, “sugar/glucose-fructose”, most thought that was another name for sugar, or sucrose. Three-quarters of Canadians indicated that they would prefer to see the term “high-fructose corn syrup” on the ingredient list, and nine in 10 agreed that sugar and high-fructose corn syrup should be labelled separately.

Members of the committee, consumers in Canada are confused and misinformed. We propose the following with respect to the ingredient list--

[The Chair, Conservative, Joy Smith]

We're running out of time and I have to cut you off. I would ask that people watch a little bit for the time. Could you end with a sentence? I hate to be rude.

[Sandra Marsden]

Change the term “glucose fructose” to “high-fructose corn syrup” and label these ingredients separately.

Thank you.

[The Chair, Conservative, Joy Smith]

Thank you so much.

Now we'll go to the Centre for Science in the Public Interest, and Mr. Bill Jeffery.

[Bill Jeffery, National Coordinator, Centre for Science in the Public Interest]

Thank you, Madam Chair.

The Centre for Science in the Public Interest is a non-profit consumer health advocacy organization specializing in nutrition issues, with offices in Ottawa and Washington, D.C. We don’t accept funding from government or industry. The 100,000 Canadian subscribers to our advertisement-free Nutrition Action Healthletter, which you have all received, funds our health policy reform advocacy. On average, we have one subscribing household within a one-block radius of every Canadian street corner, and that's rural and urban.

The World Health Organization estimates that nutrition-related disease and, to a much lesser extent, physical inactivity in countries like Canada are responsible for one-quarter of all premature deaths, or approximately 57,000 deaths annually in Canada.

Provincial governments pay the lion’s share of health costs for nutrition-related illness. For example, by 2030, health care costs alone are projected to rise from 46% to 80% of the entire Ontario government budget, if policy changes are not implemented.

The national and international character of the food supply, Health Canada’s nutrition science expertise, and the federal government’s constitutional authority make it better situated to use its regulatory and spending levers to help curb nutrition-related diseases. However, the federal government still postpones nutrition-improving regulations as if Canada has tens of thousands of lives to spare every year and as if governments preside over full treasuries and double-digit economic growth.

Recently, the UN Secretary-General Ban Ki-moon invited Prime Minister Harper, President Barack Obama, and other world leaders to a high-level summit on the prevention and control of non-communicable chronic diseases on September 19 to 20, 2011, in New York City to draft a global approach to curbing NCDs that may include policy commitments, disease reduction targets, and accountability reporting mechanisms.

We recommend the following specific federal government policy reforms.

One, commit to fully implement Canada’s strategy for sodium reduction, which is now six months old, to ensure that salt is used judiciously by manufacturers, not gratuitously, and, at an absolute minimum, that consumers get better objective information to facilitate healthy choices.

Two, promulgate regulations restricting the use of trans-fat-laden partially hydrogenated oils to permanently prevent at least 1,800 heart attack deaths annually in Canada. Provincial regulations were promulgated to rid such oils from Ontario’s and Manitoba’s school food services in 2008 and British Columbia's restaurants in 2009.

In 2009, federal government scientists also concluded that trans fatty acid levels in Canadian foods are nowhere near as low as those of foods sold in Denmark, where a regulatory ban is in place. A scientific update commissioned by the World Health Organization and published in 2009 concluded that:

The evidence on the effects of TFA and disease outcomes strongly supports the need to remove PHVO from the human food supply.

Three, mandate disclosure of calorie counts and notices about the amounts of sodium for menu items at outlets of large chain restaurants to close a nutrition labelling exemption affecting $60 billion worth of food annually in Canada, which is one-fifth of all food consumed.

While Health Canada continues to discuss menu labelling, as you heard two days ago, governments in New York City, California, and elsewhere have required calorie labelling on menus, at least, and soon regulations made possible by the Obama health care bill will require menu labelling in chain restaurants throughout the U.S.

Fourth, strengthen food labelling regulations, including mandatory front-of-pack nutrition labelling. In practice, nutrition facts tables are very useful to interested and educated shoppers, but might be more aptly named “back of pack complicated nutrition facts”. A grocery shopper trying to home in on the lowest-sodium soups or lowest-sugar breakfast cereals from any source would have to physically pick up, turn around, and keep tabs on dozens of packages for each product being considered for purchase. Likewise, finding the pasta with the most tomatoes or berry juice with the most berries remains a guessing game, no matter where one looks on the labels.

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Jeffery. You are over time. Can you wrap it up?

[Bill Jeffery]

Madam Chair, I was told I had five to seven minutes when I was preparing my testimony.

[The Chair, Conservative, Joy Smith]

Yes, and you've gone over your time. I have a timer right here. Thank you, Mr. Jeffery.

We'll now go to the Québec Coalition on Weight-Related Problems.

Who would like to give that presentation?

[Suzie Pellerin, Director, Québec Coalition on Weight-Related Problems]

Thank you.

On behalf of the Quebec Coalition on Weight-Related Problems, thank you very much for hearing us. The coalition is made up of over 100 partners from various spheres such as the municipal, school and health sectors, who all feel it is important to put in place environments where it will be easier to eat well and to move more.

Today, it is our pleasure to contribute to your reflection for various reasons. Firstly, we all think it is important to curb the current obesity epidemic. This is a complex and costly phenomenon. The cost of obesity is estimated to be $30 billion per year in Canada. Several factors have contributed to the collective deterioration of our health, but our intervention today will focus primarily on sugar-sweetened beverages, whose troubling high level of consumption is concerning. It is blamed by the scientific community and directly identified as a factor in the obesity epidemic.

It is also the only dietary habit that is constantly linked to excess weight in children. Also, it is a cause we can easily target to take action. As members of the Standing Committee on Health, you may give direction to federal government policies, and certain tax or legislative measures could reduce the drawing power of sugar-sweetened beverages and energy drinks. How? By taking action with regard to product composition and packaging, restricting the distribution of these products, prohibiting marketing directed at children, and imposing a tax on soft drinks or energy drinks.

Currently, sugar-sweetened beverages are targeted among others by the World Health Organization and the Government of Canada, as one of the major contributors to the current obesity epidemic. In fact, I want to take this opportunity to praise Health Canada's recent advertising campaign—through it the federal government really took up a position—which finally publicly associated sugar-sweetened beverages and obesity.

Sugar-sweetened beverages are mainly composed of water, sugar or its substitutes, and sometimes of natural or synthetic caffeine. Since you were given the mandate of studying caffeine additives in certain drinks, we have difficulty understanding the government's March 2010 decision to allow the addition of caffeine to non-cola soft drinks in response to pressures from bottlers. We believe that the regulatory framework should be more rigid rather than more flexible with regard to the composition of the product and its packaging, so as to make sure that the consumer is not misled.

Soft and energy drinks are available everywhere. You need only extend a hand to reach for a can. All measures, therefore, aiming to restrict their distribution in the places particularly popular among young people will be beneficial. In order to set an example, we ask the federal government to prohibit the sale of soft and energy drinks in its buildings.

The impressive top line generated by soft drink companies is highly driven by their advertising and promotion. Last May, in Geneva, the WHO promoted the adoption of recommendations to guide the efforts made by member states for the development of new policies or the strengthening of existing policies to prohibit publicity aimed at children.

We now encourage the Canadian government to go further by prohibiting marketing aimed at children, as is the case currently in Quebec. We also ask the government to make its intention clear in preparation for the upcoming United Nations Summit, next September in New York, which will also no doubt address this issue.

We all know that price is an essential factor in the decision process of a purchase. Soft and energy drinks are commonly sold at a low price or with a discount. As opposed to the price of basic products which have greatly increased over the years, the price of soft drinks has remained relatively stable. The evolution of theses prices demonstrates the profit margin these products generate, as well as the low production cost of these beverages.

Many governments have already identified the implementation of a tax as a measure to prevent problems associated with obesity. They have identified it as one of the most promising strategies for governments and a profitable one in terms of cost-health benefits.

Therefore, we propose the implementation in Canada...

[The Chair, Conservative, Joy Smith]

Thank you, Ms. Pellerin. I've given everybody extra time. Could you wind up?

[Suzie Pellerin]

Sure. It's my last paragraph.

[The Chair, Conservative, Joy Smith]

You know, the thing to remember is that we have Qs and As, so I want to make sure that all sides get a chance. You can put in things that you feel you need to.

[Suzie Pellerin]

Thank you. We propose the implementation in Canada of an excise tax on soft and energy drinks, so that the revenue generated by this tax may be invested in prevention.

[The Chair, Conservative, Joy Smith]

Okay. Thank you.

Now we'll go to Dr. Barbara von Tigerstrom from the University of Saskatchewan, please.