Health Committee on Feb. 3rd, 2011

[Barbara von Tigerstrom]

Certainly there is a lot of potential for that. It has to be a two-pronged approach of education and public awareness. It is also a matter of getting the labelling regulations right. By getting them right, I mean making them strict enough that consumers can have confidence in them and trust that if there is something on the label indicating that it is a healthy product, they have some confidence that what is advertised isn't undermined by some other risk. That's the nutrient profiling approach I was talking about. Also, it is about being open to new and innovative products, provided there is sufficient evidence behind them.

[Colin Carrie, Conservative, Oshawa, ON]

What have been some of the successful policies and practices that you've seen implemented so far that help that?

[Barbara von Tigerstrom]

In Canada, we have the regulations around health claims and nutrient content claims, which I think are helpful. We've been open to considering new claims. Some people would say we haven't been open enough and others would argue that we've been too open, so I guess you have to find a happy medium.

The key piece that's missing is that we do have to be very careful about the supporting evidence for each claim that's made, but also ensure that those claims aren't being used to market foods that have other characteristics that could create health risks at the same time as they are helping with another problem.

[The Chair, Conservative, Joy Smith]

Thank you so much, Ms. von Tigerstrom.

We'll now go into our second round of questions and answers. It's a five-minute round. We'll begin with Ms. Sgro.

[Judy Sgro, Liberal, York West, ON]

It's great to have you all here. Like the other panellists, I think we need a whole afternoon to discuss such an important topic as this one.

I will go to Dr. von Tigerstrom. On the issue of menu laws and getting more information on the menu as far as sodium content, calorie content, and so on, where would you think Canada is in comparison to the U.S. and the United Kingdom?

[Barbara von Tigerstrom]

We have some catching up to do, I would say. Right now we have a purely voluntary approach. The only time nutrition information is required is when some kind of claim is made, which is not that unusual, but that's not the majority of cases.

The U.S. has legislation in place in many different places and soon will have it nationally. The U.K. is using a voluntary approach, but it has been promoted by the government. The companies sign on and make a commitment to use the official government scheme, which again gives consumers confidence that they know it has the government's backing.

We need to think also not just about what's on the menu itself or the menu board, such as the calorie disclosure, but about that extra piece, which I would say is just as important, that of ensuring that nutrition information is readily accessible in the outlets. That would include things like sodium and fat and trans fat, as well as the calorie count that might be on the menu board itself.

[Judy Sgro, Liberal, York West, ON]

The whole discussion of voluntary versus mandatory--and I would invite anyone who would like to comment on that issue to do so--was talked about a lot in Parliament as we went through that process. Now that we've had a voluntary plan for a while and the world hasn't fallen apart, what do you think about taking the next step and moving into mandatory food labelling?

Mr. Jeffery.

[Bill Jeffery]

Are you talking about menu labelling?

[Judy Sgro, Liberal, York West, ON]

Menu labelling.

[Bill Jeffery]

Well, on the mandatory system that was in place since before it came up in Parliament in 2005, I'm aware of only one restaurant--Extreme Pita--that provides nutrition information, and it's not even on the menu; it's on a kind of separate menu.

For the vast majority of restaurants, you have to go to a website to find out the information. That turns a simple trip to a restaurant into a research project, if you want to get some useful information out of it.

There was an interesting study done by the Rudd institute in the United States. Some industrious grad students monitored about 4,000 people going into restaurants to see who among them looked for the nutrition information--at the brochures or the posters. Of the 4,300 or so, only six did, so it's an extremely low usage rate, and that's not going to lead to any kind of dietary changes.

A good study done by an economist at Stanford University showed that the mandatory system in New York City actually led to some pretty significant changes: a reduction of 14% in the calorie count for foods purchased at the Starbucks chain.

[Judy Sgro, Liberal, York West, ON]

Are there any other comments on that?

[Aileen Leo]

In terms of people who live with diabetes, especially people who use insulin to manage their diabetes, it's actually quite important for people to be able to see the carbohydrate content of the food they're about to consume. So certainly, measures that would make it easier for people living with diabetes to do that would certainly be welcome.

[Judy Sgro, Liberal, York West, ON]

I have a further question for Ms. Leo. You mention obesity a lot when it comes to diabetes. It seems a day doesn't go by that I don't run into somebody who's a diabetic, so clearly it's increasing immensely. But they're not all overweight--

[Aileen Leo]

No--

[Judy Sgro, Liberal, York West, ON]

--so where is the correlation? Even though we always lead on the issue of weight, some of these people don't appear to have any kind of weight problem.

[Aileen Leo]

No. As we mentioned in our presentation, about 80% to 90% of people with type 2 diabetes, which includes an increasing incidence of children with type 2 diabetes--it was previously diagnosed only in adults--are either overweight or obese.

But certainly, there are other high-risk groups: people who are aboriginal, South Asian, Southeast Asian, of Hispanic cultural descent, or of African Canadian descent, and people who have low socio-economic status. We see a number of high-risk clusters. Interestingly, recent research indicates that women are among the high-risk groups. As a percentage of the population, more men than women have diabetes, but women within high-risk groups bear a far greater disproportionate burden of diabetes.

So you're right when you say that there are people who are not overweight or obese, but the majority of them are.

[The Chair, Conservative, Joy Smith]

Thank you so much.

Ms. Davidson.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Thank you very much to each of you for being here this afternoon. Certainly, as others have stated, we could have a very long session and a lot of questions on this.

Ms. Leo, I wanted to ask you one in particular. I think you indicated that there was a difference across this country in the incidence of diabetes, with the east coast having a higher incidence than B.C. and Alberta. Is there a reason for that?

Am I correct? Is that what you indicated?

[Aileen Leo]

Yes. You are correct. We're going to be releasing a report in about two months that will show provincial breakdowns across the country. We've released a lot of that data already, and we'll be releasing further data next week in the prairies about specific prevalence in those jurisdictions.

But there's a distinct difference from east to west. Unfortunately, Atlantic Canada does bear a far greater prevalence of diabetes, with rates approaching 10% in places like Newfoundland. The national average is just over 7%.

The reason for this is that people in Atlantic Canada, unfortunately, have a lower income, by and large, and as I mentioned a moment ago, people with lower incomes have a greater risk of incurring obesity. On average, they are older, and people who are older--especially over 40--have a higher chance of incurring diabetes. Also, unfortunately, people in Atlantic Canada on average tend to be heavier than people in other jurisdictions, although, unlike patterns for age and income, that's more of a mixed bag across the country. So yes, they have a higher number of risk factors for incurring diabetes.

[Glen Doucet]

I'd just add that in our presentation you will note that Alberta and B.C., which traditionally have lower rates, are going to have the highest increase in diabetes. That's because their population is aging. I say to all my cohorts from Nova Scotia who moved to Alberta 20 years ago to work in the oil field that it's catching up to them.

The reality is that a lot of these rates are locked in for the next 10 years. I know a lot of the focus here is in terms of primary prevention, but as a country we really need to start focusing on secondary prevention, keeping those folks who are going to be developing diabetes healthy and keeping them from developing the serious complications.

I know a lot of the focus here is on primary prevention and how we prevent obesity and such, but maintaining healthy weights in people with diabetes is probably the best thing we can do to improve the overall health of that large segment of population. In Newfoundland that will be one in three people by the end of this decade, and it will be a tremendous burden on their health care system, and on Canada as a whole.

I'd really like to start thinking about putting the emphasis not only on primary prevention. Really, where the rubber hits the road is secondary prevention for the people living with chronic diseases, and preventing them from getting more serious complications.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Do these statistics include childhood diabetes as well, or are they adult diabetes statistics?

[Glen Doucet]

They do include type 1 and type 2. What they don't include is gestational, and we're seeing a marked increase in gestational diabetes across the country. In fact our association is looking at lowering the threshold for that because of certain factors. It also doesn't include the people who haven't been diagnosed with diabetes but we know they are living with diabetes. And that's almost a million people.

Our estimates that we've presented today are extremely conservative; we know the incidence rates are actually much higher.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

I think in your presentation you talked about--and I can't just pick it out of the literature--borderline or.... What's the definition of a diabetic or an almost diabetic? How do they determine that?

[Aileen Leo]

You have to have what's called an A1C level. It's a measurement of basically the amount of sugar in your blood over a period of time. It has to be above or below a certain threshold, and once it's above a certain threshold you will probably be diagnosed with what's called pre-diabetes. In other words, your ability to manufacture insulin is impaired to lower the amount of sugar in your blood, and as that sugar builds up you incur things like heart attacks, stroke, kidney failure, and diabetic-related blindness. Those are the major complications.

It's critically important. You must lower your level of blood glucose, because those complications can start in people, not just with diabetes but with pre-diabetes as well.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

The medical association--