Thank you very much for the invitation to be here. I'm quite pleased to have the opportunity to help the committee in its investigation and to tell you about what I've learned over the last five or six years as scientific director of the Institute of Nutrition, Metabolism and Diabetes.
I'm sure this committee is well aware of CIHR and its roles and responsibilities as the Government of Canada's health research funding agency. Our mandate is to excel, according to internationally accepted standards of scientific excellence, in the creation of new knowledge and its translation into improved health.
As you know, there are 13 institutes. When CIHR was established in 2000, we undertook an environmental scan across the mandate of the Institute of Nutrition, Metabolism and Diabetes, which includes research to enhance health in relation to diet, digestion, excretion, and metabolism. So the institute's mandate includes nutrition, metabolism, diabetes, kidney, GI, liver, and endocrinology.
So we undertook that environmental scan, and it was very clear from talking to not only researchers but policy-makers and stakeholders, such as the Heart and Stroke Foundation and many others, that the priority for this institute really should be the area of obesity and the maintenance of a healthy body weight.
Toward the end of 2001, we launched our strategic initiative and our strategic priority on obesity. I'll show you in slide 4 a little bit about the funding that has gone out the door for CIHR. But this has afforded me--originally a basic scientist in diabetes--the opportunity to learn about all of the many aspects of obesity that we need to consider. So I brought some of these lessons learned to you today.
As you can see, CIHR has accelerated funding for obesity. That figure illustrates the research funding that CIHR puts out that's relevant to obesity, and you can see that we've increased it four- to fivefold since 2000-01. We've also illustrated for you that a portion of those funds is relevant to childhood obesity. I think we would like it to be more. We've increased this through specific strategic initiatives on childhood obesity, but I think we also have a capacity development issue for researchers, who need to learn how to work with children and do studies with children. So we're working to try to build that capacity as well.
The fifth slide illustrates some random titles of projects we've funded over the last four or five years that are relevant to childhood obesity. You can see that they range from things like genetic and environmental influences on body weight, to the issue and challenge of being overweight in aboriginal communities, to trying to understand the socio-cultural environment and factors that play a role in contributing to childhood obesity. This is just a sample of the many studies that are now currently under way focused on childhood obesity.
I'll give you a few statistics in the sixth slide, because I know my colleagues from Statistics Canada and Dr. Katzmarzyk will give you considerably more data on the problem of childhood obesity. But roughly one in three children in Canada is overweight or obese. Obesity in childhood is correlated with adult obesity, and as the child gets older, if they remain obese or overweight, their prospect of being overweight as an adult increases.
Obesity in children is associated with other metabolic abnormalities, usually classified in a grouping called metabolic syndrome. That constitutes things like hypertension and high lipid levels, which are things we normally associate with adults but are increasingly being seen in children. About 30% of obese children have metabolic syndrome, which is in essence a precursor to diabetes and cardiovascular disease.
It's estimated that one in three children born in 2000 will at some point in their life develop diabetes, and we're certainly seeing younger and younger individuals developing the disease. It's very apparent in the aboriginal population that they get diabetes 10 to 20 years, on average, before the Caucasian population. Other immigrant populations are starting to experience childhood obesity as well. The impact of that is significant. If you have diabetes early in life, the quality of life associated with the complication of diabetes is certainly likely to go down.
I bring you only one set of statistics in the seventh slide about quality of life of children who live with obesity. This slide represents impaired quality of life. If you read across the first line under “physical health, impaired physical health”, when you compare obese children to healthy children, they're five times as likely to have impaired physical health, nearly six times as likely to have impaired psychosocial health, etc. That's comparing obese children with healthy children.
Even more stunning is when you compare obese children with children who have cancer and are undergoing chemotherapy. You see that even obese children are twice as likely to have impaired psychosocial health in comparison with children who are undergoing chemotherapy for cancer. It's really quite shocking, I think, how much obesity affects the lives of children.
The challenge is complex. My usual sound bite is that obesity is not rocket science; it's more complex. I don't say it's so hard and such a challenge that we shouldn't do anything about it, but to remind us that simple solutions will not really solve this problem. We need multiple levels of solutions. Really, the whole society needs to be engaged in one way or another in tackling physical inactivity and healthy eating. I know that sounds overwhelming sometimes when I say it, but I think it's part of what we need to do. And we can learn from the fact that we understand its complexity, if we embrace that complexity and think about solutions that arise out of thinking about complex systems.
The ninth slide is to remind me to illustrate to you or to make the point to you that it's not only complex from a socio-cultural environmental component or aspect but also from a biological aspect. There are more than 600 genes or locations on the human genome that in fact are associated with the human obesity phenotype. What does that mean? It means that we have quite complex biological mechanisms for regulating body weight. In fact, if you think about how much of an imbalance in calories it takes to lead to increases in body weight, only in the order of 50 to 100 calories a day imbalance between what you take in and what you expend can lead to weight gain over the course of a year. Unfortunately, like a mortgage, you compound it on a daily basis.
Actually, we have exquisitely good regulating systems for our bodies and they're regulated by a whole host of biological factors. But fat cells themselves secrete a whole host of molecules that play a role in regulating body weight. So it is complex biologically. I'm not arguing that it's biology that's causing the problem, but our biology may predispose us to the obesogenic environment that we actually live in. That's now being revealed, as our environment becomes increasingly obesogenic, with many forces that play a role in decreasing physical activity and increasing food intake.
The tenth slide is there to illustrate what some of these factors are in our socio-cultural environment that play a role. On the right, you see energy expenditure and food intake. Yes, it's really true that for the individual it's as simple, in some respects, as taking in too many calories for the number you expend on a daily basis. That's what determines whether you will be overweight or not. And it's not what you do on occasion, it's about what you do everyday and the habits we have on a daily basis. Our biology plays a role in driving how we eat and whether we're physically active. It may be surprising to think about it, but there are genes that have already been identified that actually play a role in our food-related behaviours that drive us to eat or not eat.
There are many, many factors, some of which are very proximal to us, like work, school, and home environments. Some are a little more distant to us, like our community environment, public safety, the agricultural environments we live in, even our access to public transit, that play a role in whether or not we have certain food and physical activity-related behaviours. That really goes all the way up to international factors that play a role, such as globalization of markets and media advertising.
Simply to illustrate some data around one of those areas that I know the committee is interested in, food marketing to children and youth, work was done by the Institute of Medicine in the U.S., recently published, that illustrates that food and beverage marketing to children in the ages 2 to 11 years really does influence things like food preferences, purchase requests, and beliefs about food. Unfortunately, the evidence in older children and adolescents is somewhat less clear, so they didn't conclude that this was necessarily important.
Content analysis indicates that most of the television food and beverage advertising that's relevant to children and youth really does promote high calorie, low nutrient products, and exposure to television advertising is associated with increased overweight in children 2 to 11 years and in adolescents from 12 to 18 years. It is very clear that media advertising, food advertising, does play a role in childhood obesity.
What are the common responses when we recognize the complexity of a problem, one that has many biological factors, one that has many social and cultural factors? When we think about complex problems we often go through a range of emotions about it. As an individual who was formerly obese, as I like to call myself, I've been through these emotions many times myself. We tend to think the problem is beyond hope. We sometimes despair or retreat from it. These are common across all kinds of complex problems, but what excites me is that we're now in a phase in this country, and really worldwide, where we're ready to galvanize our collective efforts and to invest significantly in trying to tackle this challenge.
We can learn from the discipline of complex systems science, and I'm not going to impart lots of academic information here, but we can learn how to deal with complex problems like obesity when we turn to that science.
I will just bring two points to you. One is that when things are this complex, individuals really matter. If you have a really complex system, you can't just necessarily, from a top-down approach, solve all the problems that exist. All of the people who live and work in different environments who are involved in the transportation sector or the agriculture sector, and even the individual who may have a weight challenge, are all important when we think about how we can solve this problem.
We need to match the complexity of the environment the person works in to the complexity of the problem. If we take that to the individual who is overweight or obese, if we live in a very complex environment and there are so many different forces that affect our food and physical activity behaviour, then it's very hard to tackle the problem. So what we really need to do is think about how we can change our socio-cultural environment to make the healthy choice, the easy choice.
A good example is if we look at the relationship between the cost of food and the energy density of that food. The cheapest foods are the most energy-dense, least nutritious foods. For people who live in any socio-economic environment, but particularly for those who live in poverty, it's easier to make the choice to buy the cheaper food, isn't it? We need to really think about some of those price structures as we try to tackle the problem.
Lots of people like to make the comparison to the problem of tobacco. I'll make that comparison and make some points about where the comparison is valuable and where it is maybe not so valuable.
On slide 14 you see a plot of cigarette consumption in the U.S. over the years since 1900. I want to make a couple of points about this picture. You see that cigarette consumption increased steadily from 1900 until about 1960, 1970. There are many forces that play roles in that, including our knowledge that meant smoking is linked to cancer. It had a small impact on the consumption of cigarettes. Even the Surgeon General's report in the U.S. had a small impact, but it wasn't really noticeable.
When did we really start to see a significant decline in cigarette smoking? It occurred when non-smokers' rights started to really take hold as a public movement. When people who didn't smoke said, “You shouldn't smoke in my environment, it's not right, I don't want you affecting my health”, it made smoking that used to be quite desirable and part of the social environment.... You'd sit around after a meal and that was the desirable thing to do. Now if you're a smoker you have to go outside; you have to go out of your way to smoke a cigarette. When our normative behaviour went from smoking as the right thing to do to smoking as the wrong thing to do, that's when you see very significant declines in smoking, not in all populations but in general.
How do we translate that to obesity? I'm not trying to suggest, as the Toronto Star quoted me as saying, that we make obesity uncool, because clearly, children and adults who are obese and overweight are already living with significant stress just because of their condition. That's not what I'm saying. What I am saying is we need to change the normative environment around food and physical activity. When we come to meetings we should have that plate of fresh fruit, not the plate of cookies. I like to refer to the plate of cookies as second-hand junk food to make the point that somebody else has made the decision about what my food environment actually is, if they offer me cookies instead of fruit.
We have to replicate that notion a hundredfold in all the things around us. There are many things, like food advertising to children, that affect what we think about food and what children think about food. Food is linked to fun for children. Why isn't physical activity the thing that's linked to fun? Why don't we get rid of that relationship? I think that's something we're thinking about.
I'm also not arguing that public education campaigns and talking about the benefits of physical activity are a bad idea in association, while maybe you won't see big drops in obesity as a result of that, but it is important to recognize that we need to change how we think about food and physical activity.
I've listed for you--and I won't spend time going over it--some of the ways to think about complex problems and complex systems, but there are many lessons we can learn, and we can talk about that if there's time after my colleagues have spoken.
One that I do want to highlight is just the notion that we need to measure effectiveness in the field. It's not worthwhile to spend public dollars on health promotion activities unless we find out what the impact of those activities are, in part because we not only need to know which ones are effective, but which ones may have unintended consequences, where in fact they might lead to a decrease in the appropriate or healthy behaviour.
We've learned through CIHR that there are ways to do this, to drive not only health promotion but data collection, through a project run out of my institute called “Canada on the Move”. It wasn't really a health promotion project. It was a project set up to try to facilitate four organizations that are doing health promotion. We need to engage, in doing this kind of work, a mechanism for them to learn about the effectiveness of their program.
Lastly, slide 17, gives you some of the lessons we learned through this project, which were recently published in the Canadian Journal of Public Health. We learned that you do need to distribute messages consistently and through multiple channels, and that health promotion and disease prevention can create innovative partnerships between industry, government, and the health charity sector.
So I think we have evidence to suggest that there are ways to tackle the problem and to get the evidence we need.
Thank you.