Health Committee on Sept. 28th, 2006

[The Chair, Conservative, Rob Merrifield]

Who would like to answer that?

[Jill Holroyd]

I can start. There is a lot of information in your comments and questions, but I'll do my best.

In terms of the data we've presented today, the goal is really to say that this is a complex issue. I think everybody can appreciate that around the table. It would be a disservice to Canadians to villainize one factor, one industry, or to try to come up with a magic bullet solution based on general opinion and informal observation, as opposed to what the facts are really telling us about Canadian eating habits.

While I'm on the issue of the data, I want to come back to the StatsCan study on caloric intake that my fellow witness took issue with. Yes, the study does point out differences between the two surveys in 1972 and 2004, but if I may quote from it, it says:

While the 2004 data cannot be strictly compared with those for 1970-1972 (National Health and Welfare 1997), an examination of results from the two surveys suggests that Canadians’ calorie consumption has not increased. On the contrary, initial findings suggest that the trend is down among males aged 12 to 64, and essentially stable among women and older men (Table 1). This is counter to the situation in the United States, where calorie intake rose between 1971-1974 and 1995-2000.

I don't want to get into a he-said-she-said, but it's to the point that it's a complex issue, and there's a lot of information out there that the committee needs to consider.

In terms of advances being made in the food service industry, again we can look at the growth in the healthier menu items that are out there now, the investments that restaurants have made to respond to consumer demand for healthier, lighter, leaner, menu options. We are seeing change in menu patterns, in what consumers are ordering at restaurants.

[The Chair, Conservative, Rob Merrifield]

Our time is gone.

Madame Demers is next.

[Nicole Demers, Bloc, Laval, QC]

Thank you, Mr. Chairman.

Thank you for coming and telling us about your efforts, both on the food services and the non-alcoholic beverages side. What you are doing in our schools is important. I should tell you that I, for one, really like the food served in restaurants, for example. And we all know that the best comfort food to eat at home when you are depressed is cheese macaroni, and it must be from Kraft.

However, when I was 12, 13 or 14 years old, I was running around all day. The number of calories I ingest today is roughly the same as 30 or 40 years ago, but I am sitting down all day. Therefore, one should not only look at calories but also physical activity, as Dr. Freedhoff mentioned, as well as the ratio between the energy a person spends during a day and the number of calories that the person ingests.

My question is for Dr. Freedhoff. There has been a very interesting presentation given earlier by Dr. Jean-Pierre Després, a specialist in waist obesity. He talked about the very easy method he developed to determine the risks associated with fat around the waist.

Do you know Dr. Després?

[Dr. Yoni Freedhoff]

What we're talking about is the waist circumference and waist-to-hip ratio as a better means of deciding the risk of weight, and absolutely--it's been known for a very long time, actually, that it is a better measure of the risk of weight, because body mass index forgets things. It forgets about muscle mass, it forgets about bone density, it forgets about racial differences; as a consequence, it's a less reliable measure. Of course, that reliability is really only in question in the lighter range of body mass index. Once you exceed a certain level, it becomes fairly incontrovertible.

You mentioned activity and its role. I wouldn't mind commenting briefly on activity and the role. People consistently talk about how important activity is in burning calories, and it is absolutely true that without physical fitness, people are far more likely to regain weight they have lost. However, the actual calories burned through exercise is fairly minimal compared to the number of calories one could restrict from the diet through knowledge and teaching.

For instance, should a person want to lose a pound in one week through exercise alone, they would need to exercise an hour a day, very vigorously, seven days a week, and not one time that week have anything to eat as a reward for their exercise--so while it is certainly a player, I think it is the minor player in terms of weight management.

[Nicole Demers, Bloc, Laval, QC]

I have another question for you, Dr. Freedhoff.

I understand that you offer a weight-loss program for better health in a private clinic setting. Is it very expensive? Is it accessible to the people most vulnerable or those who do not necessarily have the money to pay for such a program?

You also say that education is very important. In your view, it is therefore very important to promote these notions, to educate people on health, on problems associated with obesity, on the errors in the Canadian Food Guide so that people do not make the mistake to believe what it says and end up with problems.

Is that correct?

[Dr. Yoni Freedhoff]

Our program is five and a half months long. In our program a person will receive unlimited access to a dietician, with a minimum of five hours of one-on-one consultation time. They'll receive over 24 hours of group fitness within the confines of our fitness facility, as well as see our personal trainer for three hours, one-on-one. I see people every two weeks for the first half of the program, and every three weeks for the second half, but quite frankly, I'll see people weekly if need be.

The cost of our program is $1,450. It is far less expensive than the weight management program being run at the hospital, and we also have an affiliation with a company called Medicard, which provides medical loans to Canadians and would allow people to spread the cost of the program over four years, to the point where it would cost $30 or $40 a month if they wanted to enrol.

There are insurers who are paying for portions of the program and there are also some insurers who are now potentially considering paying for the complete program.

[Nicole Demers, Bloc, Laval, QC]

Thank you.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

Mr. Fletcher, you have five minutes.

[Steven Fletcher, Conservative, Charleswood—St. James—Assiniboia, MB]

Thank you, Mr. Chair.

I'll start by making a comment on Canada's Food Guide. It may be helpful to the committee, after hearing what we've heard today, to hear from the people who are responsible for putting that together and ensure that there is integrity in the food guide.

Having said that, I have two questions. I'll simply ask the questions and let the answers come as they may. On Bill C-283, Ms. Reynolds, you made a lot of excellent points. However, we still have Bill C-283 being brought forward and there must be a reason why that is occurring--even though I tend to agree with you that it is completely unmanageable, and how would you do it? Nevertheless, we have it, and I think it's fair to say it has a considerable degree of support in the House of Commons. So I'd like to give you an opportunity to address the critics of your position.

In regard to Ms. Gillis' and Ms. Farn's position on liquids, it seemed to me that you were taking opposite points of view on liquids, particularly on flavoured drinks. Is that perception correct? Having heard each other's presentation, I wonder if you could each discuss why your position is correct and the other person's is wrong. A nice little debate would be fun.

That's it.

[The Chair, Conservative, Rob Merrifield]

Ms. Reynolds, would you like to start?

[Joyce Reynolds]

I wouldn't mind starting.

Thank you for the question. I think a lot of people would say they would love to see more labelling in restaurants, without fully understanding what the practical realities are. It's the same as if you were to say, wouldn't it be great to have a minimum of five dieticians in every school across the country doing one-on-one training with students? That sounds great. There's no evidence that it would be effective, but it certainly sounds like it might be a good idea. How practical is that? How realistic is this?

We know that government doesn't have unlimited resources, and the idea of trying to do the analysis and the measurement...we know how hard it is to implement. We know the realities for the industry. Does government really understand the realities of trying to implement and enforce such a regulation? And is government really prepared to reallocate the amount of resources that would be required? There wouldn't be money left to take any other initiatives in terms of addressing this very complex issue.

[Steven Fletcher, Conservative, Charleswood—St. James—Assiniboia, MB]

The government understands that we're in a minority situation. I think we'll potentially be outvoted on this.

[Joyce Reynolds]

To try to respond to your question, I think it's a good idea in theory, but in terms of reality and practicality I think it would be almost impossible.

I have to give you an example. For instance, if you have a situation where you've implemented Bill C-283, somebody could complain and say the calorie count for a date square in a coffee shop is not accurate or is missing. You'd then need to have CFIA officials check out that date square. They would then have to check out how many of those coffee shops actually have date squares on the menu. If they found that 60% of them have date squares on the menu, they'd have to figure out how many dollars that date square generated at all of those different coffee shops across the country. Let's say it is over the $50,000 threshold. Once they figured that out, they could find that the date squares are provided by regional suppliers throughout the country and every single date square is different.

This could be the case for a Caesar salad, a club sandwich, a hamburger, or an ice cream cone. It would become a ridiculous exercise to try to implement such legislation or to measure it or analyze it, when restaurant operators are saying they can't provide accurate and reliable information in that format.

[The Chair, Conservative, Rob Merrifield]

Okay. We probably ran out of time on that subject. That's Bill C-283. We haven't seen it, and we may not see it, so we'll leave that debate for a little further on.

I will leave an opportunity for the other question, if the witnesses wish to address it.

Ms. Gillis.

[Linda Gillis]

Yes, I would like to discuss that.

In terms of looking at the data on sweet drink consumption, I think you have to look at how the studies were analyzed. Some of the studies didn't have parental involvement. It's important for children to have parents involved, in terms of food frequency, because children are not at a developmental age in order to determine the food frequency of a soft drink.

You also have to look at what they determined to be a sweet drink. A lot of those studies were not inclusive, and they didn't include Poweraid, Fruitopia, and fruit punches. They only looked at pop, or they did not define sweet drinks in a complete way.

In my research, I did a dietary history with the parent involved, plus I looked at all the sweet drinks individually, and then I had a tally for it.

[The Chair, Conservative, Rob Merrifield]

Ms. Farn.

[Calla Farn]

I hate to disappoint you, but there's not going to be a debate between Ms. Gillis and me. In fact, her study shows there's a link between sweetened beverages and obesity. As I pointed out during my presentation, a number of other studies have shown similar linkages. But the fact remains that an equal number of studies show absolutely no relationship between the two.

Targeting any one food and one solution is not the answer to the obesity issue. The answer is something much more comprehensive. Yes, look at caloric intake, but you should also look at nutritional education and physical activity.

[The Chair, Conservative, Rob Merrifield]

Dr. Freedhoff, a very short comment.

[Dr. Yoni Freedhoff]

In order for the committee to have more information, in 2001 the American Academy of Pediatrics committee on nutrition published a policy piece on juice in children. They recommend that children between the ages of one to six years old limit fruit juice intake to between 125 and 180 millilitres less than the amounts in the serving sizes being provided in the voluntary program in schools, and that kids between the ages of seven and 18 years old limit intake to between 180 millilitres and 250 millilitres.

It may also interest the committee to know that there were representatives from the Canadian Paediatric Society on that expert panel.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

Ms. Priddy, you have five minutes.

[Penny Priddy, NDP, Surrey North, BC]

Thank you.

I am aware of the debate around Canada's Food Guide. My own family physician suggested that if I were to follow it, I could go up two clothing sizes and provide myself with a whole new wardrobe. Not that it would not be fun, but it's not something I'm interested in doing.

I have two questions for you. You said that when you came for consultation, it was about whether you liked the colour or you liked the design. My two questions to you are as follows.

One, have you shared your concerns about Canada's Food Guide with the appropriate people at Health Canada?

My second question is this. Is there another food guide that you like more and are more comfortable with?

[Dr. Yoni Freedhoff]

The answer to the first question is yes, I actually did meet with Health Canada on two occasions. The first occasion was informal at a think tank on obesity in Toronto, and my views were dismissed completely out of hand.

The only other time I was given the opportunity to speak directly with Health Canada was after my views were published in the Canadian Medical Association Journal, at which time the meeting was conducted. It also became fairly apparent that while my views were being heard, there was a bit of reluctance to accept another person's views on the calories and the models.

In terms of food guides, a very well-researched food guide was created by Walter Willett, chair of the department of nutrition at the Harvard School of Public Health. Walt Willett produced something called the healthy eating pyramid. He did it the right way; he used evidence-based medicine. He took 40 years of dietary research and summarized it into a pyramid form that is very easy to understand, with non-ambiguous messages.

Then he went further and proved in a study he published in The American Journal of Clinical Nutrition that people following his food guide were more likely to be free of chronic disease than people following the American food pyramid, which for all intents and purposes is comparable enough to Canada's Food Guide that we can talk about it. His food pyramid used the Physicians' Health Study and the Nurses' Health Study—very robust data sets and unequivocal results.

Indeed, the American Heart Association released new dietary guidelines this year as a healthy eating pyramid. The guidelines explicitly talk about calories and provide resources on their websites, including charts to help people determine how many calories their age, sex, etc., would require for daily weight maintenance.

[Penny Priddy, NDP, Surrey North, BC]

My other question would be, is there anyone else you think we should hear from, or anything else you think we should see in terms of material, that would further expand our knowledge about the relationship between food, as you talk about it, and chronic disease patterns?

[Dr. Yoni Freedhoff]

Absolutely. Unfortunately, I did not have enough time in 10 minutes to talk about the actual poor recommendations with regard to health. I talked solely about calories.

I would recommend the committee call upon the Centre for Science in the Public Interest, a non-profit group. The centre's mandate is to advocate for the nutritional health of North Americans. The person who I would recommend to speak on this topic would be Bill Jeffrey.