Thank you for inviting me to speak today.
I speak to you today as a nutritionist who does community-based research in first nations communities. My focus is maternal and child health. Today I will review the evidence for obesity in children in aboriginal populations, the gaps in knowledge about obesity, the requirements for continued research, and the need for aboriginal self-government in areas such as health.
It is clear that first nations children have a high prevalence of obesity. The first nations regional longitudinal health survey showed that 26% of children aged nine to eleven were obese. However, the study did not include children from all provinces or territories, and children's heights and weights were not measured but were reported by parents, so the prevalence of obesity may in fact have been underestimated.
Results from the Canadian community health survey showed that aboriginal children living off reserve had an obesity rate of 20%, which was two and a half times the national average for children, which was 8%. In the Arctic, research has found that 19% of Dene, Métis, and Yukon first nations children aged 10 to 12 were obese. High rates of obesity have also been reported for the Oji-Cree in northern Ontario and Mohawk children from Kahnawake in Quebec.
I have been very privileged to have done community-based research with the James Bay Cree in northern Quebec since 1997. The Cree live in nine communities: five are remote, located near James Bay and Hudson's Bay; one remote inland community; and three rural inland communities.
One community-based study I did showed that preschool children in James Bay as young as two years of age were obese. So this is a problem that begins very early in life. There cannot be delays in intervention strategies until children are older.
I've just completed a school-based study to understand the prevalence of obesity and the associated risk factors in Cree children in two communities. One community was rural; the other community was remote. A local steering committee called the study “the active kids project”, and named it in Cree. Over 200 children aged 10 to 12 years participated, with a participation rate in excess of 80%. One-third of children were obese in that study.
The study also found that the majority of children had abdominal obesity. This observation supports other research studies that obesity in aboriginal peoples is predominantly of the abdominal or upper body type--that is, fat patterning around the waist and the upper body, rather than on the thighs or the lower body. This type of upper body fat patterning places obese individuals and children at additional risk for metabolic syndrome--a constellation of factors such as high blood pressure, high triglycerides, and high levels of bad cholesterol--which increases risk of coronary heart disease, stroke, and type 2 diabetes.
The study also found that liquid calories comprised a major portion of children's energy intake: 9% of calories were from sweetened drinks such as pop, fruit punch, powdered drinks, and sport drinks. Snack foods such as potato chips were the major contributor to fat in the diet. In fact, children would reduce their fat intake by 20% if they did not eat snack foods or poutine. Many children ate restaurant or take-out meals.
It was encouraging to find that children ate traditional foods such as moose, goose, rabbit, duck, beaver, partridge, and whitefish. It is interesting to note that although children did not eat much traditional food, it made a very important contribution to children's diets. For example, children consuming traditional food had higher intakes of both iron and zinc.
We found that children had low levels of fitness and were not active enough for good health. In particular, girls were inactive.
More importantly, we found that children were not happy with the way they looked. Almost three-quarters of children wanted a smaller body size than their own; whereas almost half of children with normal weight wanted to be smaller, 100% of obese children desired a smaller body size. In addition, one quarter of normal-weight children, compared to almost three-quarters of obese children, did not like the way they looked.
It is clear from these results that many children were not happy with the way they looked and that obese children were most likely to prefer a smaller body size and be dissatisfied with their appearance.
This study that I presented to you on James Bay and other studies on first nations children indicate a high prevalence of obesity. We should be very concerned with these findings.
Obese first nations children are at a potentially increased risk for type-2 diabetes, particularly because they have abdominal obesity. We must also be aware that obese children may have mental health issues, such as depression, low self-esteem, and low self-worth. They probably pick up these ideas from mainstream society, media, and TV.
As a researcher, these are the gaps that I perceive in knowledge about obesity in aboriginal children. First nations and Inuit children have seldom been the focus of health research. Knowledge of rates of obesity in children is restricted to a few intensively studied communities. We have limited data about Inuit children.
Baseline data and trend data are essential to monitor and evaluate the effectiveness of programs designed to decrease obesity rates. Studies of obesity cannot be restricted to documenting dietary intake and activity levels of children.
We have limited information about community factors contributing to obesity. If communities in which aboriginal children live cause obesity, then understanding, measuring, and altering the environment is critical to reduce the rates of obesity. The environment is not only the physical environment, such as the layout of communities, but it's also the environment of economic and social organization and cultural values.
Given the need for high-quality obesity research, I recommend that the government ensure continued financial support for initiatives such as the aboriginal diabetes initiative, the Canadian Institutes of Health Research, and the Institute of Aboriginal Peoples' Health.
It is obvious that prevention strategies are required. Because the increasing prevalence of obesity is due to rapid social and cultural changes, obesity prevention cannot be focused solely on the individual. All children must be able to maintain a healthy body weight through physical activity and a healthy diet in the presence of a supportive environment.
For this reason, community-based interventions are required. Active living and affordable healthy foods must be made available and promoted at multiple levels, such as the family, child care centres, aboriginal head start, schools, and after-school programs. Healthy foods must be made the most economical choice.
Mr. Fred Hill will be speaking today about the food mail program. Is that correct?