Health Committee on Sept. 21st, 2006

[The Chair, Conservative, Rob Merrifield]

Seeing that we have a quorum and that it's just past the time to start the meeting, we will call the meeting to order at 3:35 instead of 3:30.

I want to welcome our witnesses and the department for coming out and starting us on this very important study on childhood obesity. Just to let the committee members know, we're into a study on obesity.

I notice on the side we usually bring in snacks, and we have fresh fruit and cookies. I'm not so sure the cookies should stay. I know, Mr. Batters, that will bite a little, but maybe we should lead by example. We'll be watching to see how many cookies disappear at these meetings.

At any rate, we have a very important issue that has impacted many Canadians, and we're very intrigued with what our witnesses have to say as we move on to this study.

To let everyone know, committee members as well, we have with us Dr. Finegood from the Canadian Institutes of Health Research.

It's good to have you back. I understand we heard from you last spring and you're to answer any questions.

We'll move right to our presenters and start with the Public Health Agency of Canada, Gregory Taylor.

Maybe I'll introduce all of the presenters first and then we'll start with the presentations.

We have, from the Department of Health, Mary Bush, Kathy Langlois, and Janet Beauvais; and Debra Bryanton from the Canadian Food Inspection Agency. That's our panel for this afternoon.

We'll start with the Public Health Agency.

Gregory Taylor, the floor is yours.

[Dr. Gregory Taylor, Acting Director General, Centre For Chronic Disease Prevention and Control, Public Health Agency of Canada]

Thank you, Mr. Chair.

I'm pleased to be here today to discuss childhood obesity. Let me start by passing on the regrets of our Chief Public Health Officer, Dr. David Butler-Jones, who could not be here today due to illness. This is an important issue to him personally. I'll be representing the Chief Public Health Officer today in my capacity as director general of the Public Health Agency's Centre for Chronic Disease Prevention and Control.

I know that during your meeting last June, committee members identified childhood obesity as a key issue that required long-term study this fall. This is important work. The World Health Organization has declared obesity to be a global epidemic. In Canada, childhood obesity rates have almost tripled over the past 25 years. The health portfolio recognizes that answers to these increasing rates lie beyond the scope of individual Canadians, any one level of government, or any one sector of society. Changes can only come through collaboration with partners in such diverse areas as built environment and targeted prevention activities, in addition to providing increased access to healthy eating options and physical activity.

It will be important for governments and society to reflect on all the tools and mechanisms we posses to determine our direction forward. Today's session is an important step toward strengthening, understanding, and moving ahead in this area. This will involve taking stock of what the evidence tells us about childhood obesity, what work we have under way and can build on, and then developing recommendations on our next steps.

I want to provide you with some broad considerations to reflect on in these areas. This may help launch your discussions and provide a starting point for focusing on questions you plan to probe in greater depth.

I have mentioned that obesity is increasingly prevalent in Canada, with the most dramatic increases reported in children. This increase during recent years is likely a result of both an upward shift in energy intake--people are eating more--and a downward shift in energy expenditure; in other words, people are moving less. Obesity that begins in childhood is particularly troublesome, since the longer a person is obese, the greater the health risk.

There have also been a number of environmental changes over the past years that are considered key influences on childhood obesity--for example, dramatic increases in the availability of fast foods, which are often poor in nutrition and energy dense, or high caloric; larger portion sizes; environments that do not support physical activity; and the increase in leisure and passive leisure activities such as television, Internet, and video games.

Today there are a number of social and cultural factors that impact our own lives and those of our children. Many things that we now accept as a normal way of life, such as driving instead of walking, and eating take-out food instead of a home-cooked meal, may be contributing to growing levels of the early onset of childhood obesity.

Children are also particularly vulnerable to environmental conditions, such as reductions in school physical activity programs, food and video computer game advertising that now targets kids specifically, and choices within the home environment. We also know that ethnic racial groups vary in the prevalence of obesity. Some of Canada's most profound challenges in obesity lie within our aboriginal communities. The obesity rates for adults and children in Canada is estimated to be the highest among aboriginal peoples, followed by Caucasian, black, and Latin American populations.

Given the evidence we have accumulated to date, what have we done to address childhood obesity? Over the past few years the health portfolio, including the Public Health Agency of Canada, Health Canada, the Canadian Institutes of Health Research, and other federal departments such as the Canadian Food Inspection Agency, have developed a number of initiatives in partnership with provincial and territorial governments; other federal departments; first nations, Inuit, and Métis communities; and non-government organizations.

I want to highlight some of these initiatives for you. First there is the pan-Canadian healthy living strategy that was approved by the federal-provincial-territorial governments in October 2005. As part of the strategy, governments agreed to important targets to help support Canadians in achieving healthy weights through physical activity and healthy eating. There is also the work of the joint consortium for school health, which was created in a partnership with federal-provincial-territorial ministers of health and education to provide a coordinated approach to school health. The joint consortium develops tools to assist in the development of programs, policies, and best practices that will improve the overall health of young people and address specific issues and risk factors such as healthy eating and physical activity.

The health portfolio has been active on the research front as well. Through the Canadian Institutes of Health Research, specifically the Institute of Nutrition, Metabolism and Diabetes, the Institute of Human Development, Child and Youth Health, and the Institute of Aboriginal Peoples' Health, approximately $63 million has been invested in obesity research. In fact, the Institute of Nutrition, Metabolism and Diabetes has made obesity its single strategic priority. Of the $63 million, $9 million has been specifically directed toward new projects to address the problem of childhood obesity and $4.1 million to research obesity in aboriginal populations. The knowledge generated by these projects will help to assess and identify the most effective interventions and prevention strategy for obesity and provide evidence for sound policy decisions.

Some of the studies specific to youth have focused on understanding the challenges that children believe make it difficult to manage their weight in school, out of school, and in the family home and on developing improved methods for assessing obesity in children and adolescents. Health portfolio members have also developed and promoted national guidelines for physical activity and healthy eating to assist Canadians in their efforts to be physically active and to make healthy food choices.

The Public Health Agency published “Canada's Physical Activity Guide to Healthy Active Living”, which targets both adults and children. The guide explains how to achieve better health by making physical activity an important part of daily living. For example, it provides strength, flexibility, and endurance activities that can help Canadians have more energy, move more easily, and get stronger.

Health Canada has developed guidelines for healthy eating, including “Canada's Food Guide to Healthy Eating”. These guidelines underpin nutrition and health policies, standards, programs, services, and other nutrition initiatives across the country. “Canada's Food Guide to Healthy Eating” is currently under revision, and the release of the updated food guide is planned for late 2006 or early 2007.

We have also undertaken work to address this issue through program development and implementation, research initiatives, and public education. Likewise, provincial and territorial governments are putting into place policies and programs to address this concern. But since childhood obesity rates continue to rise, there is a growing consensus across Canadian society that more needs to be done.

As Canada is one of the member states that have adopted the World Health Organization's global strategy on diet, physical activity and health, we remain committed to improving public health through healthy eating and physical activity. The health portfolio remains committed in particular to addressing childhood obesity and to working in partnership with all sectors to develop effective and appropriate actions and interventions.

We look forward to the results of your study and to your recommendations for actions. These will become focal points for future work in this important area.

Thank you.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

We'll now go to the Department of Health.

Mary Bush.

[Mary Bush, Director General, Health Products and Food Branch, Office of Nutrition Policy and Promotion, Department of Health]

Thank you.

I'm here in my capacity as the director general of the Office of Nutrition Policy and Promotion.

As you know, healthy eating and physical activity play a very important role in promoting healthy weights and reducing the risk of obesity and overweight.

The issues related to obesity are an important consideration in the work that we do, including, of course, the revision of Canada's Food Guide.

The new food guide will in fact provide much more precise guidance about the amount of food from each food group that is appropriate for Canadians two years old and over. The guidance will be age and sex specific so that there will be no guessing, if you're of a particular age or sex, about how much food you need to consume.

More specific guidance will be given on the types of foods to choose and limit. For the first time, Health Canada is developing, with its partners, a tailored version of the food guide specific to first nations, Métis, and Inuit. In order for the guide to be an effective tool for aboriginal people, it's being tailored to specific audiences. Key messages in this tailored guide will promote eating that recognizes the importance of traditional and non-traditional foods in the diets of first nations, Inuit, and Métis consumers today.

The dietary pattern in the food guide is designed to encourage food choices that are relatively low in calories. While the food guide contains an important policy--it defines healthy eating--it is only one element within a broader comprehensive strategy needed to improve nutritional health and well-being.

Dr. Taylor referred to some national and international strategies such as the WHO's global strategy on diet, physical activity and health, the pan-Canadian healthy living strategy, and some of the initiatives that have evolved, such as the joint consortium for school health. We work very closely to ensure that nutrition and healthy eating components are being looked at. Comprehensive action by all sectors and at all levels is needed. We need policy, evidence, leadership, capacity, and information.

A comprehensive review of the literature published in the supplement to the Canadian Journal of Public Health last year on the determinants of healthy eating has confirmed the need to understand the broad factors that influence eating. It is clear that Canadians are eating too many calories for their current inadequate levels of activity. Food is everywhere. Time pressures faced by families have changed the way Canadians are eating. For the first time in 35 years, we now have national data on what Canadians are eating.

We're working closely with Statistics Canada and the Canadian Institutes of Health Research to build capacity and research opportunities using these new data. Research from these data will provide valuable insights not only into what Canadian adults and children are eating, but also into the underlying factors, such as income, that influence eating patterns.

Information and public education are components of a comprehensive strategy. Education on the use of nutritional labelling, and information on what healthy eating is, contained in such tools as the food guide, are key examples.

Action to improve nutrition is a shared responsibility, so collaboration with partners in all sectors and at all levels, including provinces, territories, health, agriculture, education, and social services are all fundamental. Canada is making important strides. It's gratifying to witness the growing prevalence of healthy offerings in schools, on restaurant menus, on grocery shelves, and at breaks in meetings such as this.

Canadians live in an environment that poses unprecedented challenges to the goal of healthy eating. We need to create the social, physical, and economic environments that will support healthy eating and make it possible.

We look forward to the outcomes of your study and the contribution it will make to future actions that are aimed at childhood obesity. Your work is critical.

Thank you.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

I don't know if it's a sobering thought or a good thought that government now knows exactly what I'm eating. I'll think about that a little while as we take our next witness. Kathy, I think you're up.

[Kathy Langlois, Director General, Community Programs Directorate, First Nations and Inuit Health Branch, Department of Health]

Mr. Chairman and honourable members, my name is Kathy Langlois. I am the Director General of Community Programs, in Health Canada's First Nations and Inuit Health Branch.

Thank you for inviting me today to highlight some of the issues related to overweight and obesity among Canadian First Nations and Inuit children, and to answer your questions.

There are good data on the extent of overweight and obesity among the Canadian population. However, it is difficult to be exact on the scope of the problem of overweight and obesity among first nations and Inuit children because we do not have the type of population-wide representative data for these children that we have for other Canadian children.

What we do know from the first nations regional health survey, and from other studies that have taken place, is that approximately 22% of first nations children living on reserve are overweight, while a further 36% are estimated to be obese.

At the same time, while we suspect that rates of overweight and obesity among Inuit children are rising, we have even less information on this population. Inuit have indicated that the current body mass index or BMI does not accurately measure overweight or obesity among their people because of their different body types.

Inuit leaders have proposed the development of an index established on Inuit norms. Until we have this information, it is difficult to provide an accurate picture of overweight or obesity among Inuit children.

In summary, however, indications are that rates of obesity among first nations are two to three times higher than the Canadian average. This is consistent with the rate of diabetes, which is three to five times higher than the Canadian average.

The causes of obesity and overall poor health among First Nations and the Inuit are complex—the results of a combination of historical, economic, and social factors. Understanding these determinants of health enables a more effective approach to the issues and needed interventions.

Poverty, income, and food insecurity--meaning access to healthy food--can present obstacles to achieving health, including healthy weights, and very real day-to-day problems for first nations and Inuit.

Low income, high cost, and lack of availability of fresh and healthy foods, especially in remote and isolated communities, contribute to the growing trend of overweight and obesity.

Awareness skills and behaviours are important tools by which individuals can impact their health, and in particular their weight. Awareness of healthy eating habits and food preparation are necessary to promoting overall nutrition and healthy weights. Understanding and adhering to nutritional guidelines and recommendations described on food labels and other educational materials are also important.

Supportive environments that encourage healthy lifestyle choices and make healthy choices the easy choices are ones in which there are healthy food choices in schools; where smoking rates are significantly decreased; and where there is strong mental wellness, including healing from the legacy of residential schools, addictions, and substance abuse.

Families living in remote or isolated communities also have limited recreational opportunities. For many communities there are basic gaps in infrastructure, such as sidewalks, which means motorized vehicles are used exclusively.

First nations and Inuit children are also not immune to the current reality faced by other Canadian children, such as reductions in school physical activity programs, easy access to junk food, video computer games, and sedentary lifestyle habits within the home environment.

There has been a loss of culture, traditional knowledge, and practices. For example, traditional harvesting, such as hunting and fishing, which is a source of physical activity, a source of cultural wellness, as well as a source of nutritious food, is diminished. The causes of this are complex, but the outcome has contributed greatly to the rates of overweight and obesity among first nations and Inuit today.

Traditional indigenous diets were nutritious and health-promoting. In general, they were low in fat, rich in protein and in complex carbohydrates. Today the diet of indigenous populations is often not adequate for good health, and the diet is typically high in fat and in simple carbohydrates, sugars, and salt.

It's also important to note that there are concerns about environmental contamination and its impact in revitalizing traditional food sources.

We also know that the issue of overweight and obesity among first nations and Inuit children is not just an issue in Canada. Lifestyle and dietary changes have occurred among indigenous populations around the world.

These factors are all direct contributors to the growing problem of childhood obesity among first nations and Inuit. The health system has one of the key levers for success; however, there are other levers, including the food industry, regulatory bodies, and the education, economic development, housing, and environment sectors. A lasting solution, therefore, requires the engagement of multiple groups, governments, and individuals.

While increased education and employment opportunities, as well as improved infrastructure within communities, are very important, Health Canada is also taking a more active role in preventing childhood obesity in several key areas. These include culturally appropriate strategies to promote healthy choices around physical activity and food, and supporting policies that result in the availability of healthy foods at a reasonable cost.

The Department of Indian and Northern Affairs plays a key role in providing social and other services for first nations and Inuit children. These services are key to the determinants of health. The committee may find that it would be of benefit to hear from a departmental representative on their activities.

It is important to note that First Nations and Inuit Health Branch works in close partnership with the Assembly of First Nations and the Inuit Tapiriit Kanatami to promote and protect the health of first nations and Inuit. Issues around childhood obesity and food security specifically are of shared interest. It may also be of interest to the committee to hear from these organizations.

Before I conclude, I will briefly outline the federal responsibilities in current programs for First Nations and Inuit children.

The federal government provides some health services to status “Indians” and Inuit on the basis of policy and historical practices, and supports the provincial and territorial governments to provide health services to all Canadians including aboriginal peoples.

The federal policy is based on a recognition that the Canadian health system has been and continues to be an interdependent system of responsibilities shared by the federal government, provincial and territorial governments, communities and health practitioners.

The current role of the federal government in providing health services to First Nations and Inuit is based on the 1979 Indian Health Policy which established the policy framework for subsequent federal programs and expenditures.

The First Nations and Inuit Health Branch supports community-based health promotion and health protection services on first nations reserves and in Inuit communities, as well as primary health care in remote and isolated first nations communities. These programs and services are delivered at the national, regional, and community levels and are managed in collaboration with first nations and Inuit.

The branch funds a number of programs that contribute to the prevention of childhood obesity. In brief there's the aboriginal diabetes initiative, which funds obesity prevention projects for children, including healthy school policies that emphasize healthy snacks, and children's camps that focus on preventing obesity through promotion of healthy lifestyles. Many of the diabetes prevention projects in communities target youth, and funding has been provided for research on lifestyle interventions that specifically reach children.

The aboriginal head start on reserve program promotes healthy physical activity and nutrition with children ages 0 to 6, while strengthening connections with first nations culture and language. The goal is to support early childhood development strategies that are designed and controlled by first nations communities. These include a focus on healthy diet and physical activity.

We also have the Canada prenatal nutrition program and our new maternal child health program. They aim to prevent childhood obesity by providing parents with the information, resources, and support they need to care for their children and themselves.

A number of activities to improve food security in first nations and Inuit communities are taking place. We're working together with the Assembly of First Nations and the Inuit Tapiriit Kanatami to develop a framework for implementing effective food security interventions. We're also working on a joint venture with retailers in the north that will increase the availability and accessibility of healthy store foods.

As well, as Mary has mentioned, we are involved in tailoring Canada's food guide to the needs and considerations of first nations, Inuit, and Métis. We know this resource will recognize the cultural, spiritual, and physical importance of traditional foods, while recognizing the role of non-traditional foods and contemporary diets.

I believe that the work this committee is undertaking will be of great value to First Nations and Inuit, and to Health Canada in terms of informing future program and policy development.

Thank you.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

We'll now move on to Janet.

[Janet Beauvais, Director General, Health Products and Food Branch, Food Directorate, Department of Health]

Thank you, Mr. Chairman.

My name is Janet Beauvais, and I'm the director general of the food directorate at Health Canada.

I'm very pleased to be here today as you begin your study of childhood obesity.

Let me begin by saying that the food directorate, as part of the Health Products and Food Branch, plays an important role in maintaining the safety and nutritional quality of Canada's food supply. We are responsible for establishing policies and standards relating to the safety and nutritional quality of food, as well as health and safety-related labelling and advertising of food sold in Canada. The CFIA is responsible for enforcing these policies and standards.

One of the key activities highlighted by the World Health Organization's global health strategy on diet, physical activity and health was nutrition labelling. According to the strategy, national governments should provide accurate, standardized, and comprehensible information to allow consumers to make healthy choices. Mr. Chair, I'm pleased to say that Health Canada published nutrition labelling regulations in 2003, after an extensive five-year consultation period. These regulations, which require that calories and the content of 13 core nutrients be listed on labels for most pre-packaged foods, came into effect on December 12, 2005.

The regulations require that this information about the caloric value and the nutrient content of a food be conveyed in a standardized format known as the nutritions facts table, which is easy to find and read on a label. The caloric value is the first item listed in this table. It was envisioned that the provision of information would not only help consumers make healthier food choices but would also act as an incentive for the food industry to produce healthier products. Evidence is mounting that this intended effect is taking place. For example, since the requirement to list trans fat became mandatory under the new regulation, a number of food companies have reformulated their products to remove trans fat.

The regulations also contain requirements for the use of over 40 nutrient content claims. These claims indicate, for example, that a food is calorie reduced; it must have 25% fewer calories than a comparable food. These claims are another tool that help Canadians choose a healthier diet and in turn encourage the food industry to innovate and develop products that, for example, are lower in calories, sodium, saturated fat, and trans fat.

Mr. Chair, I would also like to mention that Health Canada has been encouraging the Canadian restaurant industry, which is not subject to these requirements, to provide nutrition information to consumers. In February of last year, the Canadian Restaurant and Foodservices Association launched a voluntary nutrition information program that will see participating restaurants provide consumers with nutrient values that are consistent with the core nutrient label information currently required for packaged goods. Since the launch of the nutrition information program, more than 25 restaurant chains, representing about 40% of all chain establishments, have signed on to this program.

Let me conclude by saying that the mandatory nutritions fact table, in addition to nutrient content claims and the nutrition information provided in major restaurant chains, combined with education on their use, offers a significant public health opportunity to improve the nutritional health and well-being of Canadians. This information helps consumers make healthy food choices to reduce their risk of developing chronic diseases and conditions such as obesity by enabling them to compare products more easily, determine the nutritional value of foods, and better manage special diets related to chronic disease.

We look forward to the results of your study and any recommendations for action that will assist us in creating an environment that supports all Canadians in achieving healthy body weights.

Thank you.

[The Chair, Conservative, Rob Merrifield]

Thank you.

We'll move on to our last presenter, the Canadian Food Inspection Agency, Debra Bryanton.

The floor is yours.

[Debra Bryanton, Executive Director, Food Safety, Canadian Food Inspection Agency]

Thank you, Mr. Chair.

Thank you for the opportunity to appear before the committee in its examination of childhood obesity. The committee is certainly to be commended for taking on such an important topic.

My name is Debra Bryanton and I'm the executive director of the food safety directorate with the Canadian Food Inspection Agency.

As the committee is aware, the CFIA is mandated to safeguard Canada's food supply and the animals and plants upon which safe, high-quality food depends. The CFIA verifies compliance with some 13 federal acts and their respective regulations, including the Food and Drugs Act. The agency works in partnership with other stakeholders to carry out this mandate. Our more important partners are, of course, Health Canada and its portfolio organizations.

The CFIA is committed to serving Canadians by providing protection from preventable health risks, delivery of a fair and effective regulatory regime, sustaining the animal and plant resource base, and promoting the security of Canada's food supply.

With the growing public awareness about the relationship between food choice and health and access to a wide range of information, Canadian consumers are becoming more sophisticated in their food nutrition choices. Information on labels can assist consumers in making healthier choices, adapting their diet to specific needs, and in handling their food safely. Collectively, this contributes to the overall health of the Canadian public.

As noted by Janet Beauvais, the food and drug regulations were amended on January 1, 2003, to require a nutrition facts table on the label of most pre-packaged foods. The new nutrition labelling regulations became mandatory for large companies as of December 12, 2005, and will be mandatory for small companies by December 12, 2007. I must also note that due to the fact that many small companies do supply larger companies, many have already moved ahead with their nutrition information on their labels. The CFIA is responsible for enforcing the implementation of these regulations, and as we approach the end of the first year since the regulations came into effect for large companies, we are happy to report that industry has responded well to the regulatory requirements.

CFIA has taken a staged approach to the implementation of the regulations. In partnership with Health Canada, an industry education program was undertaken providing tools and educational material to assist industry in their efforts to comply with the new regulations.

The CFIA has also developed tools for stakeholders to help facilitate compliance and assist in applying the regulations. This includes, for example, the publication of a guide for food labelling and advertising. This provides policy advice and basic ground rules with respect to labelling and claims. There is also the publication of a nutrition labelling toolkit that provides guidance on the interpretation of nutrition labelling requirements under the food and drug regulations. We will continue to work with stakeholders through responding to their inquiries and providing presentations at industry meetings and seminars at their request, again to promote understanding and compliance.

Childhood obesity is one of the many health issues directly affected by consumer choice in food and nutrition. Public awareness on this issue is growing. No doubt consumers will make choices based in part on the information highlighted on product labels.

CFIA's role relating to the issue of childhood obesity is complementary to the ones of our federal health partners, Health Canada, the Canadian Institutes of Health Research, and the Public Health Agency of Canada. We support and will continue to support our health partners in tackling this issue and other public health concerns.

Thank you.

[The Chair, Conservative, Rob Merrifield]

Thank you very much for your testimony before the committee.

We'll start our questioning now. I'll start with Ms. Keeper.

[Tina Keeper, Liberal, Churchill, MB]

Thank you very much.

I would like to thank everybody for their presentations, and please excuse me for being a bit late.

I'll start off with a question, and I'm not sure who wants to take it.

This is a significant issue and it is the reason the committee has decided to undertake this study. Although we've received a lot of information about how problematic this is, the impacts it will have on our children and why it may have happened, I don't get a sense of how long this seems to have been an issue. I looked at the revision of the Canada health guide and the food guide was last revised in 1992. In 1992, was this a significant issue? How recent is the issue of childhood obesity at this crisis level in Canada?

[Dr. Gregory Taylor]

I can start that response.

It's been on the horizon and on the radar for quite some time, but we haven't had really good, accurate data until recently. Part of the data that tells us what's going on has been self-reported data, until just 2004, when the Canadian community health survey, which was done by Stats Canada, actually measured people's height and weight.

We were quite complacent in thinking that the Americans were way more obese than us because it was based on self-reported data. What we found out was that men consistently overestimate their height and women consistently underestimate their weight.

[Tina Keeper, Liberal, Churchill, MB]

I always say that--they overestimate their height.

[Dr. Gregory Taylor]

Well, we have proof of that now.

So when you actually measured people and measured children, the rates were much higher. That doesn't mean it wasn't on the radar scope, but it really does mean that the problems were worse than we anticipated.

As well, it's been particularly difficult in the aboriginal communities to get good, solid data.

Did you want to speak to that, Kathy?

[Kathy Langlois]

I think I commented on that in my opening remarks, that we don't have the kind of population-level representative data that we would need. We are aware that first nations are looking at a public health surveillance approach, and we're interested in working with them on that.

[Tina Keeper, Liberal, Churchill, MB]

And specifically the regional health surveys, then, gave you some data?

[Kathy Langlois]

Yes, they did.

[Tina Keeper, Liberal, Churchill, MB]

And you did mention that from that you gathered there was an issue that actually is an even greater crisis than Canadian children.

[Kathy Langlois]

That's correct.

[Tina Keeper, Liberal, Churchill, MB]

Your sense was that it was about two to three times....

Can I also quickly ask...you mentioned it's approximately 22%, but overweight and obesity rates might be at about 36%. So the obesity rate includes that 22%. We're not talking about half or over 50% here, are we?

[Kathy Langlois]

My understanding is that they're additive, that's correct. So it's 22% overweight and 36% obese.

[Tina Keeper, Liberal, Churchill, MB]

So we're talking about over 50% of aboriginals...and this would be first nations, right, in the regional health--

[Kathy Langlois]

This is the first nations, yes.

[Tina Keeper, Liberal, Churchill, MB]

So over 50% are dealing with a weight issue, 36% with obesity.