Health Committee on Sept. 28th, 2006

[The Chair, Conservative, Rob Merrifield]

I'll call the meeting to order and ask that members take their seats. Let's start our meeting.

This is 17th meeting of the Standing Committee on Health. I believe it is our third meeting on the study of childhood obesity. We're looking forward to a full panel before us.

The testimony so far has been excellent, and the questions equally interesting. We want to start very quickly and get into this.

We have some technology as well. We have with us Ms. Linda Gillis, registered dietitian, by video conference.

We're going to start with Ms. Gillis and her presentation to the committee, and then we will introduce the rest as we give them the floor. Would that be a fair way to proceed?

Thank you very much for your time, Ms. Gillis. The floor is yours.

[Linda Gillis, Registered Dietitian, Children's Exercise and Nutrition Centre, Hamilton Health Sciences, McMaster Children's Hospital]

Hi. I am a researcher and dietician at the Children's Exercise and Nutrition Centre at Hamilton Health Sciences. The clinic has been running since 1983, and I've been with the clinic for ten years. I want to present today some of the research I've done with pediatric obesity and nutrition.

The first study I want to highlight is one in which I had the question: is it dietary energy or fat that contributes most to juvenile obesity? This study was published in the International Journal of Obesity in 2002. I had 181 children in the study; half were obese and half were not obese. The methods I used were a dietary history, an activity interview, and I measured body fat with bioelectrical impedance.

The result I found was that it was not fat, protein, or carbohydrate that contributed most to obesity; it was actually the calories in the diet—the calories they were consuming and then the calories they were expending in energy out.

My recommendation is that we should shift our focus right away from fat and carbohydrate to focus on total calories.

In the next study I wanted to know what foods or food groups contribute most to obesity. This was published in the Journal of the American College of Nutrition in 2003. The method I used here was the food frequency questionnaire. I was looking at what foods they consume—looking more at junk foods such as cookies, granola bars, cakes, chips, and those kind of foods.

I found interesting results. I actually didn't find that junk food was different between the obese and the non-obese groups, except that chips were consumed more by obese children. But each of the foods individually and as a whole were not different.

What I found to be the biggest difference was eating out: the obese families were consuming more foods outside the home than the non-obese. The second biggest contributor was sweet drinks. This is what I call pop, iced tea, Kool-aids, Poweraids, Utopias—all those kinds of drinks. The obese had a higher sugar intake.

My recommendation from this study was that we really need to stress the harm of eating out and of sweet drinks.

In the next part of the study I wanted to look at the actual food groups. I had some surprising results here. I found that fruit and vegetables were not different between the groups. They were low in both groups, but they were consuming equal quantities of fruits and vegetables. It was the same for milk and milk products.

What I did find with the obese was that the grains and meat group were significantly greater in the obese, and interestingly this was correlated with eating out. That would be your hamburgers, your fried chicken.

My recommendation is that when eating out and shopping we need to target healthier foods. We need to target foods that are actually healthier. To give some examples, if we're going to provide apple slices but are going to put a caramel dip with it, then we're not decreasing the sugar intake. Or if we're going to recommend submarines, which are high in grain products, that's not going to help in reducing obesity.

The next question I wanted to look at was nutrient inadequacies. If the children are consuming very high-calorie and high-fat diets, are they meeting all their nutrient needs? This was published in the Canadian Journal of Dietetic Practice and Research in 2005. I had 256 children in the study, of whom 156 were obese, and I used a dietary history method to analyze their diets. What I found was that on average the children were meeting their nutrient needs, but if I looked at the percentage of children meeting their needs, I found some problems.

I found that 81% were not meeting their vitamin E needs—vitamin E is rich in healthy oils and nuts—55% were not meeting their calcium need, and 46% were not meeting the requirement for vitamin D, which is found in milk products.

My recommendation is that we have to focus on increasing healthy fats in the diet and milk and milk products. We're doing a good job with peanut allergies, but we're not stressing the value of peanuts in terms of healthy oils. Another example is, if we're removing trans fat from the diet but are replacing it with another saturated fat like palm and palm kernel oil, again we're not increasing the healthy fat.

In the next study I looked at, which was published in Eating Behaviours in 2005, I wanted to know whether obese children gain weight at different times throughout the year. I had 73 obese youth in the study, and I was looking at the changes in percent of ideal body weight over one year at two-month intervals. I found some surprising results that are quite opposite to what we see in adults. We tend to gain weight in winter, but children lost weight throughout the year, but in July and August they gained the most weight. In November and December they lost weight, but not as much, probably because of Hallowe'en and Christmastime.

My recommendation from this study is that we have to target our education prior to holiday times such as the summer and we have to promote healthy alternatives. If they're barbecuing, what are they barbecuing? What are they doing with popsicles , freezies, sweet drinks, ice cream, and those kinds of foods?

A final study I wanted to highlight was one that I haven't published yet, but this was done looking at the consequences of obesity. I was wondering if obese youth have some bloodwork abnormalities.

I had 73 obese youth in the study and I found some surprising results. I looked at their cholesterol, triglycerides, good and bad cholesterol, sugar, insulin, blood pressure, and what I found is that 76% had one cardiovascular risk factor, so these are children who are already moving on to heart disease. And 25% had impaired glucose tolerance, so they are heading to diabetes. This was also seen in a study by Sinha in 2002, and I just quote that because mine is not published yet, but it's also showing that 25% of 4-year-olds to 11-year-olds have impaired glucose tolerance.

Although I said to focus on total calories for obesity, my recommendation is that we also need to focus on the diseases associated with obesity and target fat and sugar.

In summary, my recommendations are that we educate about and provide products that are lower in calories, sugar and saturated fat, that are nutrient-dense, and that contain a healthy fat. As well, we need to look at targeting our education at certain times of the year.

Thank you.

[The Chair, Conservative, Rob Merrifield]

Thank you very much for your presentation.

We will now move on to the Canadian Restaurants and Foodservices Association. Ms. Joyce Reynolds is with us, senior vice-president of government affairs, as well as Ms. Jill Holroyd, vice-president, research and communications. It's good to have you with us.

The floor is yours.

[Joyce Reynolds, Senior Vice-President, Government Affairs, Canadian Restaurant and Foodservices Association]

Thank you, Mr. Chairman.

We appreciate the opportunity to give you a perspective this afternoon on initiatives by Canada's food service industry to promote healthy, active living.

The second slide provides a little bit of background about the CRFA, the Canadian Restaurant and Foodservices Association.

We recognize that obesity is a serious and complex societal problem and that we own part of the solution. We commend you for undertaking an in-depth study of the issue of childhood obesity and look forward to working with you and other stakeholders on effective and workable solutions.

CRFA created the nutrition and fitness round table in January 2003, and I will give you a quick overview of some of the round table initiatives.

The round table recognized that restaurant customers have a growing interest in obtaining nutrition information about the food and beverages they buy. However, given the made-to-order nature of our industry, supplier substitutions, daily and seasonal specials, as well as the wide range of dietary concerns among Canadian consumers, it can be a challenge for restaurants to provide nutrition information in an accurate, thorough, and legible way.

The nutrition information program was developed to standardize the nutrition information available to consumers and to increase consumer access to the information and awareness of its availability. The program requires participating companies to provide consumer information on the same 13 nutrient values provided on the food facts panel of packaged foods, in brochure form, at point of sale, and to let customers know that the information is available on the premises. In addition, restaurant operators are encouraged to identify ingredients that are common causes of allergies.

The program was launched in February 2005 and continues to grow. Twenty-seven companies have now signed on to this voluntary program, representing almost 41% of chain establishments in Canada.

Food service companies also spend millions of dollars a year on activities, base sponsorships, and promotions, both nationally and in virtually every community in Canada. Food service operators are involved in fundraising for children's programs, from summer camps to school playgrounds, and support a variety of organizations and programs promoting healthy living.

CRFA is co-chairing Health Canada's social marketing working group to develop and deliver messages to consumers about how to achieve a healthy, active lifestyle. Food service operators are also focused on reformulating their menu items to reduce and eliminate trans fat. CRFA participated on a trans fat task force and supported the report's recent recommendations. CRFA has also developed seminars and website information to help smaller food service operators respond to growing customer concern about nutrition and fitness.

Before I address other ideas that have been proposed to address the issue of obesity, I'd like my colleague Jill Holroyd to provide some perspective on the restaurant industry in Canada.

[Jill Holroyd, Vice-President, Research and Communications, Canadian Restaurant and Foodservices Association]

Thank you, Joyce, and thank you, members of the committee, for the opportunity to speak with you today.

In my work with CRFA, and as a parent striving to raise two healthy, active daughters, I follow the obesity issue with great interest. As legislators, you need to think deeply about the issue and make decisions based on facts, not opinions or guesswork. That's the only way to arrive at solutions that will truly make a difference for Canadians. As part of that process, l' d like to challenge some misperceptions about the restaurant industry, which I call the five myths about eating out in Canada.

The first myth is that Canadians are eating more and more meals from restaurants. In fact, the restaurant share of the household food dollar has remained relatively flat over the past 20 years. Adjusting for inflation, it has increased by just $3 a week since 1982, according to Statistics Canada data. Numerous independent consumer studies confirm that Canadians still very much lean toward preparing their meals at home, and 76% of our meals and 81% of our snacks are prepared at home.

The second myth is that quick-service restaurants are overtaking the food landscape. In fact, on a per capita basis the number of quick-service restaurants is just about the same as it was in 1983. Again, this is Statistics Canada data.

The third myth is that it's cheaper to buy a meal from a quick-service restaurant than to prepare a meal at home. Due to the relatively higher cost of eating out compared to buying food at grocery stores, spending in our industry is very much tied to disposable discretionary income. Low-income Canadians spend less of their food dollars at restaurants, including quick service, than high-income Canadians. Statistics Canada reports that low-income households in Canada, on average, spent just $3.99 per week at quick-service restaurants. It's not surprising when you see that in the past 20 years the cost of eating out has risen far more rapidly than the cost of buying food from grocery stores.

The fourth myth is that it's difficult to make healthy choices when eating out. Our industry responds quickly to consumer trends, and interest in health and nutrition has been one of the big ones in recent years. Just take a look at some of the fastest growing menu items within the past two years. Consumers are choosing sushi, salads, water, veggie burgers, and other healthier options more often. Traditional favourites such as french fries and sandwiches are losing ground. We're seeing similar trends in restaurant unit growth.

When we look at overall calorie consumption in Canada over the past 30 years, as gathered in the recent Canadian Community Health Survey, it would appear that the obesity issue is more complex that just energy intake.

The fifth myth is that people who eat at or live near quick-service restaurants are at increased risk of overweight obesity. Many studies have attempted to link quick-service restaurants with obesity, but they tend to find either no correlation or an inverse correlation, or they or fail to control for other lifestyle factors.

When Statistics Canada recently released new data on regional obesity rates, I was struck by the inverse correlation with household spending at restaurants. The provinces with higher average spending at restaurants report lower overall rates of overweight and obesity, a finding that holds true for both the adult and child populations.

Joyce.

[Joyce Reynolds]

In the short time left, I would like to focus on two proposals that we would discourage the committee from pursuing.

The first is mandatory menu and menu board labelling. I'm sure committee members are familiar with Bill C-283. The stated purpose of this private member's bill is to address obesity. This is a very resource-heavy approach for both government and industry that we believe would ultimately be unworkable and ineffective. Governments have studied menu and menu board labelling many times and rejected it for practical and well-thought-out reasons, most notably in the context of allergens. Governments recognize that a manufacturing environment cannot be equated to a food service environment, and mandated labelling would only give allergy sufferers a false sense of security.

Similarly, it would be almost impossible, even for branded chains with a high degree of standardization, to provide menu board and menu labelling that would be complete, accurate, legible, reliable, and enforceable. This is because of the frequency of menu changes and supplier substitutions, the prevalence of customized meal choices, the range of flavour and size options for menu items, and the critical role of menus and menu boards in the ordering process and speed of service.

The following slides explain the realities of the restaurant environment and the challenges involved in providing accurate and complete nutrition information that meets the needs of customers. In the interest of time, I won't go through each one, but I would be pleased to address the factors in the Q and A session.

For now, let me jump to slide 39 and draw your attention to the dangers of taking an overly simplistic approach to nutrition information. The sponsor of this bill would say, “It's not that complicated. I just want you to give the customer an idea of the calorie count.” But is it really empowering consumers to make healthy choices if the calorie count is off by more than 50%, depending on the dressing or topping or beverage or side dish the consumer chooses?

A labelling requirement focused on calories over other nutritional considerations can be misleading and may not result in the most nutritious choices. For example, if a teenager were to buy a beverage based on calorie count, she would choose several types of soft drinks and an iced tea over a glass of 1% milk or a chocolate milk. Focusing on calories could also lead a consumer to choose a small doughnut over a multi-grain bagel.

The focus on calories could have other unintended negative effects on children, including conflicts between parents and children centring on food.

Most importantly, there is no evidence that calorie labels would have any effect on people's eating habits or on obesity levels. Dietitians of Canada reference a European heart network study to highlight some key gaps in using nutritional labelling as a population health strategy for improving the eating habits of Canadians.

The resources required to try to implement menu and menu board labelling would be huge and ongoing for both industry and government. The committee must think carefully about the cost and undetermined benefits when considering such a solution.

The other proposal that I will touch on briefly is the recommendation to remove sales tax from restaurant or retail foods that are deemed to be healthy, and perhaps add some taxes to foods that are less healthy. You might think that food service operators would jump at the chance of getting a tax break on the fastest growing component of their menus. As Jill mentioned earlier, developing and promoting healthy menu items is a growing trend, and CRFA has been complaining for years about the unfair application of sales tax to food in Canada.

Meals purchased in restaurants are subject to the GST as well as provincial sales tax in most jurisdictions, while food purchased in grocery stores is tax exempt. However, using the tax system as a tool to modify consumer behaviour on the basis of nutrition would be a logistical nightmare for restaurant operators. For example, an item high in fat may contribute essential fibres and nutrients, while an item low in fat may provide few nutritional benefits. What would a counter person charge a customer who ordered the whole wheat thin-crust vegetarian pizza and then asked for double cheese and bacon? Singling out any food item in a restaurant for special tax treatment ignores the human reality that foods are eaten in combination, and health and nutrition depends upon balance as well as moderation.

To conclude, Mr. Chairman, the food service industry recognizes the seriousness of the obesity problem and the need for multi-faceted solutions that include food service. The CRFA supports greater government intervention and involvement in nutrition and active lifestyle awareness and education programs. Restaurants provide a great distribution point for consumer information, and our members have a sincere desire to be part of such a program.

Please work with us to develop and test effective, workable approaches to encourage Canadians to adopt healthy, active lifestyles.

Thank you.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

Now we are going on to the Centre for Indigenous Peoples' Nutrition and Environment, and we have with us Dr. Harriet Kuhnlein, the founding director.

The floor is yours.

[Dr. Harriet Kuhnlein, Founding Director, Centre for Indigenous Peoples' Nutrition and Environment]

Thank you very much. I'm very pleased to be here and to be able to present to you some of the work we have done at our centre over the years.

The first point I want to call to your attention is something that I tell my students every year in a nutrition and society course. We are really very successful in the human race. All of us have the taste receptors, the chemical receptors, that drive us for sugar, salt, and fat, and we get too much of it. We have to figure out how to adapt and manage our environment to keep ourselves healthy.

The second point is that food security and the human right to adequate food are now part of our international definitions through the United Nations Food and Agriculture Organization, and the Human Rights Commission. We recognize that food for everyone needs to be available, acceptable, and accessible, as well as sustainable.

Indigenous peoples have probably a disproportionate amount of ill health related to obesity and especially to diabetes. My specialty is looking at traditional food systems of indigenous peoples and trying to understand the evolution of food systems from some hunting and gathering traditions and other food system traditions in the world.

Our indigenous peoples in Canada consume a wide variety of market foods, as well as traditional foods from their culture. The market foods, of course, they buy from the store. Each of the cultures that we have in Canada has a wide spectrum of species of traditional food. There are up to 200 different species that they know about: highly nutritious meats, fish, and wild plants. Within the plants, we mean especially berries. The major grains are wild rice and maize. We have the research to show that children are eating less of this high-quality traditional food than their parents do. Our research at the centre has actually been primarily with adults. The maximum daily average of energy consumption from traditional foods by community children is somewhere around 10%. So only about 10% of their calorie budget is coming from their traditional food. In contrast to this, 40% of their calorie budget is coming from sugar and fat and highly refined grains, what everyone refers to as junk food.

The factors that influence how indigenous peoples purchase their food and make decisions about what to feed their families are just like those for everyone else. They think about cost, and they think about how healthy things are, how much traditional food they have available, what market food is there, their children's preferences, and so forth. There is also some concern about contaminants in indigenous people's food systems at this point in time, but it's a minor issue for people who depend on land-based food systems for their traditional food.

So the patterns of daily energy intake vary. There are rural-to-urban differences. For example, there is less junk food being consumed in urban diets of indigenous peoples. This seems counter-intuitive, given that only a maximum of 10% of their food energy is coming from traditional food. They can have more traditional food in rural areas, but the junk food is less pressing in the urban diets because in the rural areas, especially in the remote communities, the amount and extent of poor-quality food is just overwhelming. There are also the north-south differences, with more people in the south using less and less of their traditional food. The most traditional food we have consumed is in the Arctic.

We have the research to show that there is better daily dietary nutrient adequacy when at least one daily serving of traditional food is contained in the diet. When people consume that, they are consuming less sucrose and fat. This is from a Journal of Nutrition paper that's been highly quoted.

We also know that more education and income result in better diets; and also, more breastfeeding and less junk food result in less childhood obesity.

So by way of solutions, we need to have more understanding of food patterns of indigenous peoples and how to improve them in our communities throughout the country. And this takes some intervention research and dissemination of findings. The research capacity of the CIHR can look into this. But we know that food security is important to indigenous peoples to prevent obesity as well as diabetes. So the general feeling of the researchers in this field is that people should be consuming more of their traditional food. It's the best food they have at this time. We should ensure breastfeeding, and improve the quality of market food that is available, accessible, and acceptable in communities. And this may take education on how to prepare some of these foods. It's quite an issue there.

It's important to reduce sugars and replace refined white carbohydrate with whole grains, reduce fats and trans fats--we've made some real advances there--and increase the omega fats that are found in fish as well as oils, and have more fruits and vegetables. It's an important point that when indigenous peoples were consuming all of the animal--all of the organs, and the brains, and the eyes, and all of those things that they have of the animal--they had all of the nutrients that we now are consuming from fruits and vegetables. And now since they're getting away from that, we have to encourage them to eat fruits and vegetables with which they are not totally familiar.

So community education is the way to go, from pregnancy through early childhood to schools and parents. We can use traditional food knowledge as a platform upon which to build education on contemporary food. And I think it's important to reduce the marketing strategies and access to junk food and beverages for children in these communities. Shelf exposure, TV commercials, and availability of junk foods in schools and public places all play a role. We know that there are--it's published now--20,000 to 40,000 TV commercials for food available to children in our Canadian environment.

Thank you.

[The Chair, Conservative, Rob Merrifield]

Thank you very much for your presentation.

Now we have Refreshments Canada. Ms. Calla Farn, the floor is yours. You're the director of public affairs.

[Calla Farn, Director of Public Affairs, Refreshments Canada]

Thank you very much for the opportunity to be here today.

In the next 10 minutes I'm going to share with you some industry information and some information about what the industry is doing to promote healthy, active lifestyles, particularly among children and youth. But the main message I want to leave with you today is that we want to be part of the solution. We want to work with all stakeholders, including government, on meaningful solutions to really address this problem.

Let me start by introducing Refreshments Canada. We're an industry association representing more than 40 brands of the types of beverages that we all drink every day: bottled water, juices, juice drinks, sports drinks, soft drinks, and so on. We represent the industry in regulatory public policy and commercial issues with all levels of government. We're also linked with other stakeholders on issues relating to the refreshment beverage industry.

Our key objectives include promoting beverages as an important part of a healthy, balanced lifestyle; promoting innovation and availability to meet consumer demands; and developing industry initiatives to support healthy, active lifestyles, particularly among youth.

To give you a quick snapshot of the industry itself, our members alone represent a $5-billion-a-year industry in Canada, with 12,000 direct and 20,000 indirect jobs in every region of the country. We have more than 100 facilities across the country and an annual payroll of about $500 million.

We're here today to talk about childhood obesity. You've heard before, and I'm sure you'll hear again, that obesity is a serious and complex issue. No single food or single ingredient is to blame. As a result, unfortunately, there is no easy solution. We believe that demonizing foods, pointing fingers, blaming, and banning foods will not help. In fact, many experts say that bans can actually have a negative impact by making the food more attractive, increasing the likelihood that it will be over-consumed. We believe that if we really want to have an impact on this issue, we need a comprehensive approach, focusing not only on healthy food choices but also on physical activity and nutrition education.

We have to teach children the importance of moderation and balance, and I'm going to tell you a little bit about what our industry is doing in that area. But again, I can't stress enough that we want to work with government on solutions.

In terms of beverages, it's important to understand that they're vital to a healthy, balanced diet. They provide hydration, nutrition, energy, and refreshment. All beverages can contribute to hydration, which is especially important for children. In a document called “Step Right Up to Healthy Eating: Fueling the Young Athlete”, Dietitians of Canada notes that children have a poor sense of thirst and need to be reminded to drink during sports, and that while water is a good thirst-quencher, many children will drink more when their beverages are flavoured.

While all beverages can be part of a healthy, balanced diet, the key, as in everything we eat and drink, is moderation and balance. The beverage industry offers a wide range of products choices and packaging sizes to meet the needs of all consumers.

We know that obesity is a result of calories in, calories out. In other words, if we consume more calories than we expend, we're likely going to gain weight. But the survey that Jill mentioned earlier, the Statistics Canada Canadian Community Health Survey, shows that caloric intake for both boys and girls between the ages of 5 and 19 actually declined between 1972 and 2004. In fact, it declined for most other groups as well. I'm not pointing this out to say, hey, therefore food is not the problem, so let's focus on physical activity. But what this does show is that if caloric intake among children has declined over that time, then their level of physical activity has declined even more, to create the balance.

So again, to solve this problem, children have to consume fewer calories but increase their exercise. We have to focus on both parts of the equation: healthy eating and physical activity.

It's not just overall caloric intake that's declining. Calories from soft drinks have also fallen. Soft drinks, as you know, have been targeted as one of the main culprits in the obesity crisis, but data from Statistics Canada shows that the amount of soft drinks available for consumption has dropped by 9% since 1998. Our own industry data confirms that there's a definite shift from regular soft drinks to bottled water, juices, and other non-carbonated beverages, and our industry is trying to accelerate that shift. That's what our voluntary school guidelines are all about. We recognize that schools are a unique environment.

Our guidelines address both the product mix and the package sizes available to students at school. They're designed to be age-appropriate, recognizing that the school environment of an elementary school is very different from that of a high school. There's a huge difference in ages, maturity levels, body sizes, activity levels, nutrition requirements, and so on.

There is one thing we are focusing on at all grade levels. What we're trying to do is reduce the number of calories and increase the nutritious beverage choices for all students while they're at school. By doing this, we hope to help children develop healthy habits that will benefit them for the rest of their lives. Here's how the guidelines work.

In elementary and middle schools, only 100% sweetened juices, bottled waters, and low-fat milk will be sold. In addition, the package sizes will be capped at 250 millilitres in elementary schools and 300 millilitres in middle schools. A number of dieticians we consulted supported the graduated package size, based on the increasing ages of the students.

In high schools we will offer a wider range of beverages, but we will still maintain the focus on low-calorie and no-calorie beverage options: high school students will have access to the juices, waters, and low-fat milk, but in addition they will have available a wider variety of low-calorie and no-calorie options, such as diet beverages. As well, they may have juice drinks and sports drinks, provided they don't exceed 100 calories per container, and the size of the containers at high school levels for the juices, waters, sports drinks, and juice drinks will be capped at 355 millilitres, again recognizing the older students.

Finally, at least 50% of the beverage options offered in the high schools must be water, low-calorie, and no-calorie beverage options.

These guidelines are already in effect for new and renewing school contracts, and it is our hope that they will be fully implemented by the 2009-10 school year. The phase-in time is needed for a number of reasons: first, it recognizes our existing contractual obligations; and second, it gives industry the time it needs to develop new products, redesign packaging, and enhance vending capabilities in order to meet the spirit and letter of our guidelines.

As I mentioned earlier, students are already shifting toward juices and waters; our guidelines will simply reinforce and accelerate that shift. We believe our guidelines are a solid step in the right direction, and we hope they show a positive commitment on behalf of our industry to being part of the solution.

We also hope that the information presented, including contradictory findings on the slide on page 11, clearly show there is no black and white solution. For example, a study in 2006 showed a direct association between soft drink consumption and weight gain in adolescent girls; however, another study showed no relationship between consumption of sweetened beverages and fat mass in healthy males and females aged 8 to 19. In 2003 a study showed time spent watching television and the number of soft drinks consumed were significantly associated with obesity in 11- to 13-year-olds; however, another showed no linear relationship between sweetened beverage consumption, BMI, and total energy intake in 10-year-old children.

So again, this shows there is no conclusive evidence pointing toward any one target or one solution. We hope this committee will consider and discuss all of the available information.

The bottom line here is that whether or not there's a cause-and-effect relationship, a focus only on the caloric intake will only address one part of the problem. The evidence tells us obesity is caused by a number of factors, including a decline in physical activity; an increase in sedentary activity; lack of awareness, knowledge, or education; cost and availability of food; safety concerns; and on and on. Clearly, the solutions have to be multi-sectoral and multi-level. It's truly time for all stakeholders to come to the table.

We're here today to tell you that we want to do our part to work together to really start to make a difference. I thank you for your attention, and again, we thank you for the opportunity of being here today.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

Now, from the Bariatric Medical Institute, we have medical director, Dr. Yoni Freedhoff. It's good to have you with us. The floor is yours.

[Dr. Yoni Freedhoff, Medical Director, Bariatric Medical Institute]

Good afternoon. I want to thank the committee for inviting me here to speak today.

I'm a practising physician. I'm one of only three Canadian physicians certified by the American Board of Bariatric Medicine, the only medical body in North America currently offering certification in medical weight management.

Since April 2004, I've dedicated my practice exclusively to the treatment of obesity, opening the Bariatric Medical Institute, where I work daily alongside a registered dietician and a certified personal trainer. Using an evidence-based approach, we do not require specific diet plans, products, injections, or supplementation. Instead, we utilize education, motivation, and support in helping our patients achieve sustainable weight loss.

We've enrolled over 700 patients, with 80% of those completing our five-and-a-half-month program achieving medically significant weight losses, as have 100% of those completing our subsequent year of lifestyle maintenance.

Perhaps the first thing our registered dietician teaches our patients is not to follow Canada's Food Guide, as it simply does not reflect medicine's understanding of the role of chronic disease, and recommends far too many calories.

I've been asked to talk to you about the impact of the food guide on childhood obesity; however, it is impossible to restrict the focus solely to children, as study after study report that the family food environment and parental dietary behaviours have a very dramatic impact upon the development of childhood obesity. Therefore, my focus will be on the food guide and its contribution to obesity in Canada.

When Canada's Food Guide was last revised in 1992, the number of recommended servings for all food groups were increased significantly, as shown in the attached chart. Health Canada explained the increase as a shift between the foundation diet approach and a total diet approach. Semantics aside, according to Statistics Canada, since the release of the 1992 food guide, the average daily consumption of calories by Canadians has increased by over 18%, and that's reflected in figure one.

I'm going to diverge from my prepared statement. I know that Calla and Joyce have both referred to a study that was published by Statistics Canada. What neither mentioned to the committee is the fact that the note on that actual table states that comparisons cannot be made due to the difference in methodologies in collection. The diagram I've included with my documents is actually based on 40 years of annually collected plate waste adjusted food disappearance tables, a far more robust data set.

Over the same time period, from 1992 until now, obesity rates in children aged six to 17 have doubled, and in adults they have increased by 65%. These increases are in stark contrast to obesity rates between 1977 and 1991, where, according to Statistics Canada, the prevalence of obesity among adults was virtually unchanged. It would certainly follow that if we ate more servings, we would consume more calories.

So what are these servings that Canada’s Food Guide refers to? That’s a question that most Canadians can’t answer. In fact, Health Canada’s own research revealed that Canadians had a very poor understanding of what constituted a serving, perhaps due in part to the fact that the servings recommended by Canada’s Food Guide do not correspond with those found on nutrition facts labels. Despite this, the revised guide retains them and actually expands upon them.

The confusion will likely worsen with the proposed guide’s suggestion to use half the size of our palms to help us with meat serving sizes. Believe it or not, research has been done on palm volumes, and they have been found to vary by as much as threefold due to natural normal variation in the population. If you don't believe me, look at the palm of the person sitting beside you.

The weight of half the size of my palm in ground beef is 91 grams; my wife’s is 56 grams--dramatically different--and both weigh more than the guide’s recommended 50 gram serving size.

Health Canada’s calorie models and serving sizes rely on the information found in the 1997 Canadian Nutrient File. Unfortunately, Canadians’ serving sizes rely on what they can buy in their supermarkets, and to the best of my knowledge there are no 1997 nutrient file superstores in Canada. This discrepancy between Health Canada’s definition and the average Canadian’s application of serving size helps to explain what I feel is a dramatic underestimation by Health Canada of the number of calories their food guide leads Canadians to consume.

To give you an example, this past weekend I went to my local supermarket and looked at their bread section. While the 1997 nutrient file, and consequently the food guide, conclude that a slice of bread weighs 28 grams, that was true with only two of the 31 loaves of bread I saw. Of the remaining loaves, over two-thirds weighed 60% more than expected by Canada’s Food Guide.

Remember, if there is more of a specific food there are more calories, and obesity's currency is calories. If, for one year, the only thing I did differently was eat one slice of the 45-gram bread in place of the 28-gram bread, I would gain as much as 5.2 pounds. Why? Calories.

In her 2004 report, Healthy Weights, Healthy Lives, Ontario's Chief Medical Officer of Health, Sheela Basrur, stated, that “body weight is the relationship between 'energy in' and 'energy out'” . The energy in of course is measured in calories, not foods, yet the food guide and Health Canada have a habit of explicitly stating, and I quote, “Follow the food guide to make healthy food choices and maintain a healthy weight”.

Unfortunately, choosing healthy foods does not necessarily mean choosing an appropriate number of calories. Healthy eating has to do with the foods you choose, whereas weight management has to do with the calories you choose. You can gain weight eating only salad if you eat enough salad, and you can lose weight eating only ice cream if you choose not to eat too much.

In what I see as a mind-boggling omission given a rapidly worsening epidemic of obesity, conservatively costing us $6.6 billion annually, resulting in 57,000 premature deaths between 1985 and 2000, the proposed revision to Canada's Food Guide to Healthy Eating provides zero guidance on calories, aside from vague, utterly useless statements like “Try not to eat too much more or too much less”, ”Be aware of your portion sizes”, and “Choose foods that are lower in Calories”. The fact is, by failing to provide guidance on calories, Health Canada puts Canadians at a dramatic disadvantage at managing their weights.

The easiest analogy for calories is money. Before you buy anything, you need to know how much money you make, and how much whatever you want to purchase costs. It's the same with calories. How can you make an informed decision on what to eat if you don't know how many calories you burn? I wonder how many people here know how many calories they burn in a daytime? If you knew the sandwich you were considering had more than half the calories you burn in a day, would you still buy or eat that sandwich? Why did Health Canada spend so much time and effort on new labeling requirements if they refuse to teach Canadians how to interpret and apply the first and most important value on the label—calories?

Health Canada's lack of guidance to Canadians on the treatment and prevention of obesity is not restricted solely to the food guide. Despite being labelled an epidemic by the World Health Organization, the Centre for Disease Control, the Canadian Institute for Health Information, the Canadian Medical Association, and virtually every major medical and public health organization in the world, it may interest committee members to know that on Health Canada's own website, obesity is not listed in the section on diseases or conditions or in its section on food and nutrition or in its section on healthy living. In fact, the only place where you can find obesity mentioned on Health Canada's website is in an A-to-Z index, where there are two links—the first to an information sheet on cardiovascular disease, and the second to Canada's Food Guide.

In my view of the role of Health Canada, I would have thought Canada's Food Guide would be reflective of the best available evidence for the role of diet in the prevention of chronic disease, as well as serving to help stem the rising tide of obesity in our nation. Unfortunately, in its current state, it does neither. My understanding is that Health Canada feels that the revised food guide, in its current form, is ready for release.

Today, I urge the committee to request that the Minister of Health not release the revised Canada's Food Guide until the concerns of this committee are taken into consideration. Furthermore, I recommend that calories be explicitly discussed in Canada's Food Guide, with guidance more useful than simply telling Canadians to eat less of them. Given the tremendous selection available to consumers, Health Canada's reliance on out-of-touch, unrealistic, and already-outdated 1997 nutrient file data as the basis for the revised guide's calorie models means that the vast majority of Canadians of all ages following the food guide will in fact continue to gain weight, eating far more calories than Health Canada's models predict.

I would recommend Health Canada revisit food labelling so as to ensure that the servings listed on Canadian food labels actually correspond with Canadian food guide recommended serving sizes. Currently they do not, increasing confusion.

Lastly, I recommend that the processes by which decisions are made in the recommendations for Canada's Food Guide be reviewed. Frankly, the dietary recommendations stray so far from mainstream scientific and medical understanding of the role of diet in the prevention of chronic disease that I am at a loss to explain this discrepancy. I hope this committee can shed some light on what influences may be at play here, before the food guide is finalized and released.

Thank you very much for your time and attention.

[The Chair, Conservative, Rob Merrifield]

Thank you very much for that testimony.

We've all had a little jolt of reality, and we're feeling bad about the cookies and calories we just had at the start of the meeting. Nonetheless, let's hear from our last individual, from Food and Consumer Products of Canada, Ms. Phyllis Tanaka.

We'll hear from you, and then we'll start our questioning.

[Phyllis Tanaka, Director, Food and Nutrition Policy, Food and Consumer Products of Canada]

I am here on behalf of Food and Consumer Products of Canada. FCPC represents companies that make and market the majority of the prepared foods and household commodities that Canadians use every day. In fact, over 70% of the food and beverages on grocery shelves in Canada today are manufactured by FCPC members.

The food and beverage industry recognizes that childhood obesity is a significant health issue. We realize that turning the tide on the rising rates of childhood obesity and the chronic diseases that go hand in hand with obesity will take time and will require the efforts of all sectors of society.

In that context, I thank the committee for this opportunity to speak to you as you gather information from all sectors of society on this very important matter. I realize we have very limited time, so I have provided you all with a copy of our report. I hope everybody has a copy at hand.

The Canadian food and beverage industry's report on diet, physical activity, and health is based on the results of a survey conducted by our member companies in 2005. It captures benchmark data on the food and beverage industry's activities in support of healthy, active living. We assessed the survey results data against the World Health Organization recommendations on what the food and beverage industry should do in support of childhood obesity. Their recommendations can be found in their 2004 report, Global Strategy On Diet, Physical Activity and Health.

We used the World Health Organization recommendations as a benchmark to measure our progress--a report card, if you will. I am very happy to say that the results of our benchmark study demonstrate industry's strong commitment to promoting healthy, active living. And I know that in 2007, when we conduct our next survey, we will find that the food and beverage industry has built on what is already in place.

Our report gives focus to four key areas: product development and reformulation; providing consumers with information; responsible advertising and marketing practices; and promoting healthy, active living. With time limits in mind, my comments are specific to what industry is doing with their products and how industry plays a role in making sure the Canadian consumer is an informed consumer.

Canadian food and beverage companies have invested significantly in both product reformulation and new product development. They have given particular focus to products in the “healthier for you” category. In fact, in 2004, 62% of the companies introduced new products designed to be healthier choices, and 62% reformulated products to make them healthier.

In the report, you will find data on changes made to products specific to fats, sugar, sodium, fibre, omega 3s, and vitamin fortification. I will give mention to the results as they relate to fat, sugar, and sodium--nutrients that were given special mention in the World Health Organization report.

Our survey data show that half the companies reformulated their products to reduce trans fats, and one in five introduced new products with no trans fats. Further, 41% introduced new products with less fat, and 13% introduced products with absolutely no fat.

On the sugar front, 13% introduced new products with no sugar at all, while 22% introduced new products with reduced sugar, and 13% reformulated products to reduce the sugar content.

With respect to sodium, new products with reduced salt content were introduced by 13% of the companies; reformulations to reduce sodium content were completed by 25% of the companies.

Industry has also focused on portion size and packaging matters. In 2004, 23% of the companies made packaging changes to address concerns about portion sizes being too large. Half of those companies introduced smaller packages, and 42% introduced smaller portions.

I realize that rattling off percentages is not very exciting. The message I want to convey is that industry is giving focus to “healthier for you” product development. When looking over our report, please note that there are some great examples of these products on pages 8 through 11.

I will spend the balance of my time speaking to the food and beverage industry's contributions to empowering consumers. Consumers need information to make informed choices in support of a healthy lifestyle.

You already know, through Janet Beauvais from Health Canada, of Canada's state-of-the-art mandatory nutrition labelling program. Food and beverage manufacturers provide consumers with standardized nutrition facts and information on their product labels. The nutrition facts table spells out the calorie count and the nutrient content with respect to 13 core nutrients. It is a powerful tool in the hands of consumers. It facilitates product comparison and assessment at point of purchase.

You may not be aware of the other ways in which the food and beverage industry facilitates consumers being able to make informed decisions. Individual corporations and industry as a whole support initiatives to ensure that consumers are informed. Individual corporate initiatives include websites and call-in centres. Consumers can tap into these resources for product-specific information and for information on healthy eating and healthy lifestyles. Individual corporations and FCPC also work with third party organizations such as Dieticians of Canada, the Heart and Stroke Foundation, and the Canadian Diabetes Association towards helping the consumer to be well informed.

For example, through FCPC, industry supports a great program called Healthy Eating is in Store for You. This education program of the Canadian Diabetes Association and Dieticians of Canada is web-based. It features a virtual grocery store tour and educational materials that help consumers understand how to utilize the nutrition facts table in making food selections.

Again, more great examples are contained in our report. These can be found under “Customer Information” and “Promotion of Healthy Lifestyles”.

While these partnership examples speak of what industry is already doing, I would like to end by speaking of an opportunity that FCPC has explored with Health Canada. In a report by the Institute of Medicine of the National Academies, entitled Food Marketing to Children and Youth: Threat or Opportunity?, the food and beverage industry is called on to use its advertising and marketing expertise in support of promoting messages on healthy living.

In keeping with the IOM recommendations, FCPC approached Health Canada with an offer from food and beverage companies to provide $5 million of in-kind advertising and marketing support to match the government's investment in their healthy, active living program, Take the First Step.

We believe the government's social marketing message, combined with our industry's ability to reach millions of consumers, could make for a very powerful partnership. We certainly encourage government to consider resuming discussions with industry through FCPC.

I sincerely hope I've given you a sense of the food and beverage industry's commitment to healthy, active living in support of addressing the serious issue of childhood obesity. I too ask that this committee and the government work with the food and beverage industry in addressing this issue.

I thank the committee for its attention.

[The Chair, Conservative, Rob Merrifield]

Thank you very much for all of your presentations. They're very good.

I will open the floor up to questions, but before go to those, I just want to ask Ms. Gillis whether she is still with us, hanging in there. All is well?

[Linda Gillis]

Yes, I'm fine.

[The Chair, Conservative, Rob Merrifield]

Okay. I'll just remind the committee that she is there, and you can address questions to her as well.

We'll open it up. Ms. Dhalla, you have five minutes, and then we'll share your five minutes with Mr. Thibault.

[Ruby Dhalla, Liberal, Brampton—Springdale, ON]

Thank you very much, Mr. Chair.

I want to take the opportunity to thank everyone for their presentations. They were quite informative and helpful.

I have a question regarding what was mentioned by Dr. Freedhoff from the Bariatric Medical Institute in regard to your comments about Canada's Food Guide and perhaps the lack of consultation by Health Canada. First of all, could you perhaps tell me a little bit about your institute, and who funds the institute, and how your program works for medical weight loss?

[Dr. Yoni Freedhoff]

Sure. We are co-funded, I suppose, by OHIP. OHIP covers my services as a physician, and the patients who come to see us will pay privately to see the dietician, participate in our on-site fitness facilities, and receive one-on-one personal training as well.

In terms of the food guide and the consultation process, I'm not sure--which is why I think it would be terrific for the committee to investigate exactly how this works. I do know that industry is certainly there every step of the way. By no means am I suggesting necessarily that industry has influenced change to the recommendations, but what I am saying quite clearly is that the recommendations made by Canada's Food Guide simply don't reflect the best available evidence as to what would be the diet most likely to help prevent and minimize chronic disease in Canada.

It's something that boggles my mind--I used that word earlier. I really don't understand how there could be any recommendations being made other than those that would protect and promote the health of Canadians. I don't understand how that process has gone on. I know that the consultation process parts that I attended were restricted primarily to marketing, with questions as to which diagram I liked best and which colour I liked best, and certainly not substantive discussions.

[Ruby Dhalla, Liberal, Brampton—Springdale, ON]

Were you involved in the process of discussions to ensure that the food guide reflects the cultural diversity of Canada's ethnocultural groups and also the first nations community, and includes the foods that are perhaps special to those communities?

[Dr. Yoni Freedhoff]

Certainly one of the things that have been promoted is the fact that in the pictorial representations of foods, there are pictures of more ethnic foods. As far as my involvement goes, I had none.

[Ruby Dhalla, Liberal, Brampton—Springdale, ON]

What about anyone else on the panel in terms of their consultations with Health Canada, if they had any, to ensure that the food guide was reflective?

[Dr. Harriet Kuhnlein]

There is going to be a separate food guide for first nations, Inuit, and Métis, and that is now under development.

[The Chair, Conservative, Rob Merrifield]

Mr. Thibault.

[Robert Thibault, Liberal, West Nova, NS]

Thank you very much, Mr. Chair.

Thank you to Ms. Gillis for her presentation. I thought it was quite factual, and it came to conclusions that I can understand. It seemed to me to be quite realistic, based on the data that she studied.

I find it to be in contrast with the food services presentation, which drew conclusions from a lot of the same data but quibbled with words and drew conclusions that were--I'll let you prove me wrong--self-serving.

It may be true that if you do a statistical analysis, Canadians eat as many meals at home as they would have 50, 40, or 30 years ago, but those meals have changed considerably. A lot of it is fast food. You call it quick service, but it's fast food that you don't buy at the drive-through necessarily, but at the grocery store, and stick in the oven or the microwave for a few minutes. Whether it be Pizza Pops, TV dinners, or pizzas themselves, and all that type of food, it's industrially produced, having very low health quality in what's in them.

The same could be said of restaurant services. When you spoke of the percentage of money being spent in restaurants, whether it's a high-income family or not, and the high amount being spent in restaurants doesn't necessarily translate to obesity or food quality than lower amounts, I don't think you're taking into consideration the evolution of the restaurant. Fast foods have gone up the slide. It used to be A&W and McDonald's, but we're into the Pizza Delights, the Boston Pizzas, and all sorts of fast foods that are out there that are perhaps a little bit more upscale but are serving industrially processed foods, that have no chef in the kitchen, that don't buy vegetables and fruit and eggs, and their inputs are basically thirteen ingredients that come pre-packaged in plastic in the back of a tractor-trailer, are dumped in the back of the restaurant or food service place, and are mixed together, or are sent out, put through the warmer, and presented to people as very low-quality food. I think there would be a difference with the homestyle restaurant that we might know, a large differentiation.

We have started to see the fast food group advising people and having some quality food, and I think that is a good move, but that was a volunteer effort, and we read of pullbacks, drawing back out of that area. I have reservations when we look at bills that are going to impose regulations on how we present our products in restaurants, or fast-service food stores, or in grocery stores themselves, but my reservations become hard to argue when I don't see advancement of that. I hear the recognition at this table, but it doesn't translate.

I hear the soft drink industry saying it wants to promote those things, but I watch TV and I understand, like any 13-year-old, that if I drink enough Coca-Cola, or Pepsi, or 7UP, number one, I'm going to own the swimming pool, and number two, it's going to be surrounded by beautiful, nubile bodies, scantily clad 12 months a year. It's only $2.25 a can; it's not a bad deal. But in reality it doesn't work like that. And I see the same type of advertising or promotion of a juice, whether it be reconstituted juice or whether it be fruit flavour added to a bit of liquid and a lot of sugar. I don't see that differentiation.

So I worry a bit about the message we're hearing today and whether we're getting real advancement from the food service industry in healthy living and promoting true choices for consumers.