Health Committee on Feb. 26th, 2007

[Prof. Tom Sanders]

I think there has been public support for restrictions on controlling confectionery, soft drink, and crisps advertising targeted at children generally. I think there have been some casualities from this across-the-board ban. One of the ones that's quite interesting is that cheese--we can't advertise Canadian cheddar cheese, I'm afraid, on British TV now in the watershed hours of children. There are some foods that have been hit by this, like breakfast cereals, which have come off. I think the other thing you need to bear in mind is that only some television channels in the U.K. carry advertisements. The BBC, for example, does not have advertisements.

I am doubtful whether it will have a significant impact on eating behaviours because the purchasing behaviours are mainly determined by when people go around shops and stores and see what's on offer there and the prices. I think the downside is that it will have an adverse effect on some of the program makers to children's television, the loss of revenue.

[Michael Chong, Conservative, Wellington—Halton Hills, ON]

I'm not sure if any of the other panellists have any comments on my questions.

[The Acting Chair, Liberal, Carolyn Bennett]

You still have a couple more seconds there.

[Michael Chong, Conservative, Wellington—Halton Hills, ON]

The reason I ask this question is because last weekend I was watching television, and I was sitting with my two-year-old flipping channels. I went through a children's program, and during the advertisements I noticed that they were advertising a high-sugar-content breakfast cereal, and it was being marketed clearly to my two-year-old because it was all in cartoons. It clearly wasn't targeted toward adults.

[The Acting Chair, Liberal, Carolyn Bennett]

I wouldn't mind following up on Michael's question. We also have a problem with the marketing to Michael's two-year-old. It is a very short ad that then drives people to the Internet--maybe not the two-year-old--for an hour-long mystery tour that actually is just filled with more and more advertising for this particular breakfast cereal.

One of the reasons we're cautioned about the advertising on television is that it's there on the Internet anyway. I think we are seeing evidence now that they're using their little time on the television to drive people to the Internet for huge periods of time.

I'm very keen that we in Canada understand, in order to have evidence-based policies, what you are using in terms of evidence, in terms of things that have actually changed behaviour. Do you have access to biometric data that actually shows that weights are becoming healthier?

Also, I was pretty impressed with some of the studies we've seen on pedometer use, that kids who were exposed to pedometers in physical education classes tended to choose the activities that got them higher scores, and that ended up being evidence-based.

So questions on two things: one on the ads, but also can you talk a little bit about the evidence that would be used for public policy that would actually change behaviour?

[Prof. Tom Sanders]

Can I just follow along on the breakfast cereals? Children are unlikely to get fat from eating breakfast cereals, simply because breakfast cereals are not that high in calories and the amounts consumed aren't high. The sugar concern is mainly one about rotting their teeth, rather than actually being one about obesity.

I wouldn't say that is a primary concern, but there is an issue generally about the marketing of food to children. That needs to be addressed, and some companies are now taking on a view of not doing that. In the U.K., Mars recently announced it wasn't going to target children.

When you look at that, it's very important that you also expect the same sort of thing to be happening on the Internet as a corporate policy. A lot of pressure can be put on through the boardrooms of companies to react to how they market food to children.

[The Acting Chair, Liberal, Carolyn Bennett]

On the issue of biometric data, we are feeling here that Statistics Canada, in the survey on kids, and certainly our population health people, very much want access to height, weight, and maybe waist circumference as a way of monitoring programs and being able to see whether certain communities are doing better, so that their approaches could therefore become best practices.

What do you have in terms of evidence around actual weights? I think Professor Mackett's study showed actual pedometer use as being at least helpful in his analysis. I also want to know if you have any evidence that it actually is motivating kids to get higher scores.

[Prof. Roger Mackett]

I don't think there's much evidence of that. What we were trying to do was experiment just to measure children's everyday activity. We didn't want them to do more exercise because they were wearing the monitors, because that would rather upset the experiment.

I'm afraid I don't really know the answer to your question on whether wearing a pedometer helps. A lot of free pedometers are given out in all sorts of places, sometimes by people selling food. They certainly do seem to work in the short term in terms of encouraging children to run around a bit more, but I'm not sure there is much evidence of the long-term effects of them having much benefit.

Maybe my colleagues know better.

[Prof. Tom Sanders]

Can I just comment about biometric data? Weighing children and taking measurements is an area of great sensitivity. Certainly, probably the most reliable measurement of adiposity is waist measurement. This doesn't require coming into quite close contact with children. Girls in particular are very sensitive about that.

You also have to be very careful about the way in which height-for-weight data is used and whether children are classified or labelled as obese or overweight. In the U.K., we are using new international standards for relative body weight, and those standards tend to slightly overclassify children into the overweight or obese classification when compared with the previous systems.

There is no doubt that waist sizes have been going up in the U.K. That's quite an easy one, in terms of actually knowing the waist sizes of the trousers that children have. That's a way of monitoring this.

[The Acting Chair, Liberal, Carolyn Bennett]

Thank you.

Is there a possibility of doing this by taking the identifiers off, the way we do in medicine? You don't know which kid it is, you just need to know what the waist size of the classroom is. Maybe we need to go to Marks & Spencer and ask about husky and chunky kids, or how many more pairs of pants they're selling one way. Is that being done?

[Prof. Tom Sanders]

They're not being individually tailored. It's almost like being weighed at the checkout and then being told that this is your calorie load.

There has been a very large cross-sectional study in the U.K., looking at doing these measurements relative to height and weight and seeing if eating behaviours are different between children who are overweight and those who are not overweight. They don't actually reveal any striking differences, but there is a major problem in that children who are overweight tend to under-report food intake. Specific types of foods get under-reported. Chocolate is a well-known one for being under-reported, for example.

[The Acting Chair, Liberal, Carolyn Bennett]

Sandy.

[Dr. Sandy Oliver]

If your aim is evidence-based policy, then I think it's very ambitious to think you could test out some programs, some interventions, and see a clear link with changes in weight. I think the time scale and the variability are so great that that sort of measure is too challenging. Weight is very good if you want to see a general trend in changes, but not to inform your evidence-based policy. Probably the best you could do is to look at observed behaviour. That is something that is much shorter-scale. In time scale, it's much easier to see and manage in a regular study.

[The Acting Chair, Liberal, Carolyn Bennett]

Thank you.

The last question is from Mr. Hawn.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Thank you Madam Chair.

We've talked a lot about programs, results, and so on, and I guess it comes down to how we assess that. What I'd like to ask--and perhaps Jane Holdsworth may be the best one to start--is how you anticipate measuring the results of all these programs. What are your expectations? When do you expect to be able to measure the results so you can decide whether programs have been effective or not?

[Dr. Jane Holdsworth]

With regard to the food labelling, we're participating in a research study with the Food Standards Agency that will look at the various labelling schemes in the market here in the U.K. We'll look at how they have changed people's attitudes towards foods and knowledge about them, and also whether that's changed their behaviour. They're scoping the piece of research at the moment, and it'll take 12 to 18 months. We anticipate that in about 12 months' time we should have some initial results of that large joint study.

At the same time, having introduced the scheme ourselves onto the front of manufacturers' packs, we are doing a tracking study. We did a baseline study last October and are now tracking how people's behaviour changes as a result of the labelling being introduced. We'll look at things like awareness of the label and usage of it, detailed understanding of what the label is telling them, and claimed change in their behaviour or knowledge about the food they're eating. That is ongoing. We have another wave of research happening fairly soon.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

And what about any of the other programs about childhood obesity and things like type 2 diabetes? They're obviously going to take a while to measure. When do you think that might happen?

[Prof. Tom Sanders]

I think type 2 diabetes is relatively uncommon amongst children. Obviously, with increasing body weight, the risk goes up, but most of the children would not acquire it until their late 20s or 30s.

I do think monitoring weight, particularly waist circumference, is important, but I think it needs to be anonymized. You don't want a child going home with a relative body mass index on their report, as is being proposed. You need to be thinking in the longer term, two or three years down the line, and not expect to see results in six months or one year, but at least be able to stem the proportion of children who are above one of the cut-off points. Relative body mass index is quite good for groups of children, but it's not very good for defining whether individuals are specifically overweight. Some children are more muscle-bound; others have relatively more fat, and fat is lighter than muscle.

[The Acting Chair, Liberal, Carolyn Bennett]

Thank you very much.

Thank you all for being with us today. We are going to go and have a healthy lunch before we go to Birmingham in ten minutes.

Thank you very much.

[The Chair, Conservative, Rob Merrifield]

I would like to call the meeting back to order.

Christiane Gagnon has a question.

[Christiane Gagnon, Bloc, Québec, QC]

Mr. Chairman, you know I tabled a notice of motion. Could we deal with this motion today? I believe we have a quorum. We were just waiting for you. We could pass or reject the motion asking for an audit by the auditor general of the Common Drug Review.

Could we set aside some time at the end of the meeting for this?

[The Chair, Conservative, Rob Merrifield]

You've given us notice of motion. We will take it at the end of the meeting. First we'll hear from our witness.

We have one more individual who would like to contribute to our dialogue before we complete our study on childhood obesity. We want to welcome Joe Harvey from the Health Education Trust in Great Britain.

[Joe Harvey, Director, Health Education Trust]

Thank you.

[The Chair, Conservative, Rob Merrifield]

Thank you for taking the time to be with us.

We'll give you the floor and listen to your presentation.

[Joe Harvey]

Thank you very much, Mr. Chairman.

I'm not exactly sure what you want us to work over today, but my understanding is that it would be helpful for me to give you a brief introduction to what I do, what the Health Education Trust does, and where we find ourselves within the national context right now. Then perhaps we'll pick up the conversation from there on in.

Are you happy with that?