Health Committee on April 23rd, 2018

[The Chair, Liberal, Bill Casey]

Welcome to the 101st meeting of the Standing Committee on Health.

We're here to continue our study on Bill S-228, an act to amend the Food and Drugs Act (prohibiting food and beverage marketing directed at children).

We have four groups today. Each group has 10 minutes to make an opening statement.

We have from the Coalition québécoise sur la problématique du poids, Corinne Voyer, director, and Clara Couturier, research analyst, public policy. From the Sport Matters Group, we have Lindsay Hugenholtz Sherk, senior leader, and Erica Wiebe, Olympic gold medalist in wrestling. From the Association of Canadian Advertisers, we have Ronald Lund, president and chief executive officer, as well as Chris Williams, vice-president, digital. From the Childhood Obesity Foundation of British Columbia, we have Dr. Tom Warshawski, chair of the Stop Marketing to Kids Coalition.

Dr. Warshawski has a presentation, but it has not been translated into French so we need unanimous consent for him to be able to present it. The translation is in the works, but it just didn't get done in time for the meeting.

Do committee members give unanimous consent to have it only in English?

[Some hon. members]

Agreed.

[The Chair, Liberal, Bill Casey]

There are graphics he'd like to use, and we have unanimous consent.

We'll start with the Coalition québécoise sur la problématique du poids for 10 minutes..

[Corinne Voyer, Director, Coalition québécoise sur la problématique du poids]

Mr. Chairman, I will do my presentation in French.

Ladies and gentlemen of the committee, thank you for your welcome today.

My name is Corinne Voyer, and I am the director of the Coalition québécoise sur la problématique du poids. I am accompanied by my colleague Clara Couturier, who is our organization's research analyst in public policy.

The Coalition québécoise sur la problématique du poids is a project of the Association pour la santé publique du Québec. The coalition's mandate is to demand changes to legislation, regulations, and public policy in order to encourage the development of environments that favour healthy lifestyle choices and that contribute to preventing obesity and weight-related issues and chronic disease. The Weight Coalition is supported by around 450 partners, half of which operate in the realms of health and research, municipalities and schools, or in the areas of the environment, nutrition, and physical activity.

The Weight Coalition would first like to express its support for Bill S-228 and for the objectives set by Health Canada's overall strategy for healthy eating.

In Canada, 60% of adults and almost one third of children are overweight. The extent of the problems linked to obesity and chronic diseases has major consequences, not only on the health of Canadians, but also on the overall economy and on provincial health care systems. Urgent action is therefore required to implement a variety of prevention measures. The science is clear: poor diet contributes to the development of obesity and of a number of preventable chronic diseases.

For a number of years, advertising for food and beverage items intended for children has caught the attention of health professionals, researchers and, more recently, the Government of Canada. Advertising influences dietary behaviours, knowledge and preferences among children. The great majority of products directed at children are of poor nutritional quality and contain elevated levels of sugar, salt and saturated fats.

The Weight Coalition recommends the following four courses of action for the federal government.

First, use the Quebec act that prohibits commercial advertising directed at children and use the application guide of that act in order to specify what constitutes advertising directed at children under 13 years of age.

Second, for unhealthy food and beverage items intended for children, limit the use of trade marketing strategies using packaging, containers and displays in windows and on shelves.

Third, as a monitoring measure, require large food and beverage companies to disclose the amounts they spend each year to target children and teenagers.

Fourth, establish a program to oversee advertising directed at teenagers from 13 to 16, who are largely targeted by and sensitive to those strategies.

In Quebec, the Consumer Protection Act has banned commercial advertising to children 13 years old and younger since 1980.

Before the age of 13, the cognitive and social development of children does not allow them to grasp the persuasive intentions of advertisers or to exercise critical judgment. Children can be manipulated and are vulnerable to the advertising directed at them. When the Quebec act was tested in court, the judges recognized the cognitive vulnerability of children of that age in terms of advertising messages, as well as the unethical character of this commercial practice.

To define advertising directed at children, the Quebec act considers three criteria: the nature of the product, the way in which the message is presented, and where it is presented.

Given that the Quebec act targets all products, not just food items, it has exceptions including shop windows, shelving, containers, packaging and labelling of food products. This is why marketing strategies directed at children still exist in Quebec grocery stores. Federal legislation should fill those gaps created by the exceptions set out in the Quebec act.

If you consult the guide to the application of the Quebec legislation, you will notice that it details legal criteria that make it possible to determine whether an advertising message is directed at children younger than 13. The guide considers platforms like television, the web and cell phones. Logos, mascots and sponsorship are also considered as advertising messages that may well target children.

Since the current bill seems to exempt sponsorship from the banned advertising practices, the Weight Coalition recommends reducing the potential harm of this exemption by authorizing only sponsorship provided in a way that does not generate the interest of young people, sponsorship, therefore, that is considered to be discreetly mentioned.

In addition to being inconsistent in terms of the mission of some organizations, it seems contradictory to expose children to advertisements for unhealthy food and beverage items, if we want to encourage physical activity.

We also want to draw the committee's attention to the importance of criteria to define what constitutes an unhealthy food item. If the legislation were aligned with the strategy for labelling on the front of the package, as proposed by Health Canada, it is critical that the daily quantity of food items directed to children be adjusted.

Since 2009, the Weight Coalition has been pointing out commercial practices that seem to be contraventions of the Quebec legislation on foods and beverages. Those complaints are sent to the Office de la protection du consommateur, which has responsibility for enforcing the act in Quebec. A number of the allegations have ended up as guilty pleas on the part of the large companies, some of which currently take part in the Canadian self-regulatory program.

Here are some examples to illustrate how the legislation is applied in Quebec.

In 2015, Coca-Cola, the owner of the Fanta brand, was found guilty of having violated the act because of its product placement and sponsorship in a play area in an amusement park. The water games area was completely decorated in the colours of the drink brand and featured characters with bottles of Fanta in their hands. The characters were placed at a height that made them easily seen by the children. In addition, they were located next to the mechanisms that operated the jets of water. I even brought some photographs that I can distribute. Some pictures show the play area before the advertising was withdrawn and others show the area after Coca-Cola withdrew its advertising.

In 2017, Kellogg Canada admitted doing advertising directed at children on its website. The complaint dealt with puzzles and colouring activities based on the brand's children's characters. Underneath the drawings was a blue banner carrying the name of the cereals and also of the company. In addition, Kellogg provided kits for organizing birthday parties, with hats that you could print bearing the brand's characters and focusing directly on children.

In conclusion, I will say that there is a clear consensus on the need to prohibit advertising for food and beverage products that have little nutritional value and are directed at children. The government has the duty to protect children from commercial influence exercised through food advertising. In the food industry, self-regulation, through the Canadian Children's Food and Beverage Advertising Initiative, that was launched by Advertising Standards Canada, is clearly unsatisfactory, whereas the Quebec legislation has definitely demonstrated its effectiveness.

Given the prevalence of Canadians who are overweight, and the international recommendations on limiting advertising directed at children, Canada must immediately champion strategies that will have a major impact and that will allow Canadian children to grow and develop in a positive dietary environment that will encourage them to make healthy food choices.

Thank you.

[The Chair, Liberal, Bill Casey]

Thanks very much.

Now we'll go to the Sport Matters Group for 10 minutes.

[Lindsay Hugenholtz Sherk, Senior Leader, Sport Matters Group]

Thank you, Mr. Chair.

Honourable members of Parliament, I truly appreciate this opportunity to participate in this discussion as you review Bill S-228.

I'm also joined by Erica Wiebe, Olympic and most recently Commonwealth Games gold medallist in wrestling.

[Applause]

Erica and I are here today representing the Sport Matters Group. The Sport Matters Group is a coalition of over 80 sport, physical activity, and recreation organizations, who together promote values-based sport at all levels of the Canadian sports system. Our remarks today represent the interests and shared opinion of grassroots, amateur, Olympic, and Paralympic sport organizations across Canada.

As a sector, we welcome the federal government's efforts to improve the health of our children and youth by protecting them from unreasonable marketing tactics that promote unhealthy foods. We welcome the opportunity to distribute and amplify the important message carried by Bill S-228 across the Canadian sport community, while augmenting it with complementary messaging around the benefits of an active lifestyle. However, while we fully support any government effort to help young Canadians make better nutrition choices, there will be serious repercussions if the new legislation as currently constructed wrongly prevents the related companies and sponsorship categories from investing in sport programs for children and youth.

Sponsorship creates real opportunities for kids of all ages and backgrounds to get involved and provides a foundation so they can access sport. It helps to advance key principles of the Canadian sport policy by enabling sport activities to be more available and more inclusive. It encourages collaboration between sport organizations, governments, and the private sector, with a shared goal of improving the health of our young people.

In its currently drafted form, Bill S-228 would likely prevent, dissuade, or diminish the likelihood of partnerships in this sector for sport organizations in Canada. This would significantly shrink the available sponsorship market and prevent partnerships with brands that currently have some of the most established track records of investing in sport, physical activity, and recreation. Lack of sponsorship would result in increased costs and fewer children and youth would be able to access sport programs that are ultimately intended to help combat obesity. We are asking this committee to consider exempting sports sponsorship not only at the community level, but also those critical partnerships at the provincial and national levels, where sport organizations receive significant support that has a direct impact on the preparation of our Olympic and Paralympic heroes.

Sport in Canada is significantly reliant on sponsorship. Without private sector funding of sport organizations, events, and athletes through sponsorship and other forms of marketing partnerships in Canada, substantial portions of the system would lose commercial and financial viability. Approximately $1.98 billion is spent on sponsorship in Canada. Together, professional and amateur sport account for 53% of the sponsorship industry. Partners, such as Tim Hortons, McDonald's, Coca-Cola, General Mills, Subway, Kraft, Booster Juice, Boston Pizza, Panago, Gatorade, Clif Bar, PowerBar, Danone, Pinty's, Starbucks, Nestlé, and Wrigley's, to name a few, play a significant role in sports sponsorship. Should the food and beverage category be prevented or dissuaded from ongoing investment in Canadian sport, it would substantially diminish the market size and available funding options.

Several organizations contributed to this presentation and I want to highlight some of the impact statements they provided to us. Both Canada Soccer and Hockey Canada, two of the highest participation sports in Canada, have indicated that their affiliates at the provincial, territorial, and regional levels would lose many millions of dollars of investment in programming, impacting approximately 470,000 children participating in each sport. Those numbers do not take into account the impact of hundreds of thousands of children participating in Timbits hockey and Timbits soccer, which are managed separately and directly by Tim Hortons.

At the 2018 Winter Olympic Games in Pyeongchang, athletes supported by sponsors likely to be impacted directly by Bill S-228 won 38% of Canada' medals. Meanwhile, 20% of the medals were won by athletes who were sponsored by beverage companies specifically. It should be further noted that sponsors within this community commonly self-police with respect to responsible advertising.

We have heard from more than a few national sport organizations which have already been informed by existing sponsors that they do not intend to renew their investments as a result of Bill S-228. The bill is still two years away from being enacted and we are already feeling the effects in the amateur sport system.

To further contextualize the potential impact of Bill S-228 on the Canadian sports system, it should be noted that the sponsorship sales process is becoming increasingly challenging for amateur and grassroots sport in Canada. Decisions to sponsor are taking longer than ever before and are being scrutinized based on criteria against which amateur and grassroots sport typically do not perform well, such as broadcast reach, syndication, and attendance numbers.

I also want to point out how this will impact sports sponsorship at the community level. We all know that the majority of community sponsors are food and beverage companies, such as the local Subway franchisee or pizza restaurant. How will the local swim club cover the cost of providing meals for their volunteers during a swimming competition if they can no longer receive cash and value-in-kind contributions from their local restauranteurs?

We also fear a downstream impact of the bill. If organizations such as Hockey Canada and Canada Soccer are already starting to feel the pinch, what will happen to smaller organizations that do not have large participation numbers but still compete for sponsors and play an important role in creating programs for children to be active in such sports as swimming, skating, athletics, and cross-country skiing?

Speaking of smaller participation sports, I think this is a perfect segue for Erica to tell us about her story.

[Erica Wiebe, Olympic Gold Medalist (Wrestling), Sport Matters Group]

Hello, Mr. Chair and honourable committee members. I'm here to share the athlete's voice, and specifically the realities of Canadian athletes today.

I grew up in Stittsville, Ontario, just down Highway 417 from here, and I relocated to Calgary, Alberta, to train with the Canadian national wrestling team when I was 18 years old. For many years I was living on AAP, the athlete assistance program, as I accumulated student debt and earned a degree at the University of Calgary.

In the first summer I moved to Calgary, I worked two jobs while I represented Canada at my first junior world championships. There I came 14th.

My first sponsor came a number of years later, and it was a local restaurant that offered to give me free meals. It was huge.

Two years before the Rio Olympics, I received my first financial sponsor, who committed to support me with $1,000 a month in the lead into Rio. I went from living off my carding cheque, which was $1,500 a month to cover rent in a big city, food, clothing, and everything, to making $2,500. That was huge for me. I felt rich. That's the reality of many Canadian amateur athletes today. Through that small, impactful amount, I was able to make the decisions that allowed me to walk out onto the mats at the 2016 Olympic Games and leave no stone unturned. I had committed everything to preparing for that moment, and singing O Canada on August 18 on top of the podium is something that I will never forget.

Olympic moments like mine inspire the art of the possible in all Canadians, but often it becomes so much more than that single moment of inspiration. Since the Rio Olympics, among many things, I've visited the Canadian Armed Forces in Kuwait, done wrestling clinics in Iqaluit, worked with refugees in Ottawa, and spoken to over 20,000 youth across our country. Without private sponsorship, I don't know if I would have had that moment and that platform to inspire all Canadians. Private sponsorship was essential for me, and it is essential for the athletes across Canada just like me who may face the reality of chasing their dreams on a shoestring budget.

Bill S-228 as currently drafted would mean a substantial drop in private sector contributions to sport at every level, from grassroots to high performance. This in turn would mean cutting off support programs to thousands of children and youth right across the country, and it would substantially marginalize the financial sustainability of an already underfunded Canadian sports system. These obviously would be unintended and opposite effects of what the legislation is intended to do, but they are very real considerations. If the goal is to develop healthier kids, then the government should remove the barriers for youth today to access physical activity opportunities. It should also encourage more private sector sponsorship in sport in Canada, not less.

Thank you.

[The Chair, Liberal, Bill Casey]

Thanks very much.

Now we go to Mr. Lund from the Association of Canadian Advertisers.

[Ronald Lund, President and Chief Executive Officer, Association of Canadian Advertisers]

Good afternoon. My name is Ron Lund. I'm the president of the Association of Canadian Advertisers. With me is Chris Williams, our vice-president, digital. We thank you for the opportunity to appear before this committee.

To begin, I want to underscore that ACA shares and supports the government's objective of reducing childhood obesity. To foster this support, over the last year, ACA has chaired a steering committee comprised of the largest food and beverage manufacturers in Canada, food service and restaurant operations, and their respective national associations.

In fact, for more than a decade, food and beverage manufacturers have strived to reshape the landscape of marketing to children in Canada through the voluntary children's advertising initiative, or CAI, promoting better-for-you dietary choices and healthy lifestyles to children under 12.

As you all know, the CAI is not without its detractors, and we know we can do better. That's why industry supports regulated restrictions for advertising foods and beverages high in sugar, sodium, and/or saturated fats to children, and that these restrictions must apply to all food and beverage companies. While these regulations must be effective, they also must be evidence-based, doable, and targeted to the intended audience and outcome without costly overreach or other unintended consequences.

Even with the promised amendment to Bill S-228 to define children as being under 13, significant amounts of Health Canada's approach will in fact capture a much broader audience than just those under 13, namely adults, with obvious charter implications. Health Canada's proposed definition for “child-directed” is particularly problematic. Quoting from the document, for television, “child-directed” marketing of food and beverages would be prohibited on weekdays from 6 a.m. to 9 a.m. and from 3 p.m. to 9 p.m., and on weekends from 6 a.m. to 9 p.m.

These proposed time bans for television are tantamount to a complete ban of all food and beverage advertising. For example, of the top 100 programs reported in the fall ratings by Numeris, 60% of these programs would be captured under Health Canada's proposal, effectively banning food and beverage advertising to adults.

The definition of “child-directed” for the Internet is similarly ungrounded. The consultation document refers to child-directed marketing on the internet as including “all unhealthy food and beverage marketing on websites, platforms and apps that are popular with children, even when these digital channels are intended for adults.”

Health Canada presupposes that all digital advertising works the same as broadcast. The language as written in fact would preclude most publishers and tech companies from accepting any food or beverage advertising.

A ban on food advertising to adults on television is not, and certainly should not be, the objective of Bill S-228, and exposes the bill to risks of a challenge. There's also a significant economic impact. Bill S-228, in combination with what Health Canada has proposed to support the bill, would have a serious impact on the Canadian economy, and not only on sponsorships, but in many other ways, especially with the struggling broadcast industry.

ACA commissioned an economic analysis that demonstrates the impacts of restriction on food and beverage advertising will be severe. It will reduce advertising revenues by between $860 million to $1.1 billion per year, including by $300 million to the already ailing broadcast industry. It could reduce GDP by between $5.4 billion to $7.28 billion. It could reduce employment by between 22,000 to 30,000 person-years. Wages and salaries earned by Canadians would drop by between $1.6 billion to $2.11 billion per year. Provincial taxes would drop by between $225 million to $300 million, and federal taxes would drop by between $306 million to $407 million.

It's really important to realize that the promised amendment to define children under 13 would actually have very little impact on these numbers.

We have three concerns. Our first concern is with the term “unhealthy” in Bill S-228. It demonizes food and beverages, and is out of step with other Health Canada initiatives. Second, the language and factors to determine whether an advertisement is directed primarily at children is imprecise and opens the door to regulatory overreach. Third, Bill S-228's coming into force provision leaves no time to prepare or execute.

To address these concerns, we have proposed amendments to the bill and we offer a few other proposed partnership solutions as well.

Let me start with the amendments. The actual language is at the end of the document. I had a hard time reading them, so I just summarized them here. We propose the following:

As has already been committed to, amend the age to define children as under 13. Replace all references to “unhealthy food” with the term “foods high in” as a determination by which foods can or cannot be marketed to children under 13. Right now under Bill S-228, positively regarded food products such as apple juice, cheese, and yogourt would be branded as unhealthy. In fact, defining foods as unhealthy is contrary to the current policy and practice. The Food and Drugs Act does not define “healthy”.

Moreover, Health Canada and the CFIA prohibit the use of the word “healthy”, which is considered a health claim. Consistent with the recommendations of dietitians, the terms “healthy” and “unhealthy” may be used to refer to a healthy or unhealthy eating pattern or a healthy or unhealthy diet, but not to individual foods.

The “high in” framework for nutrient thresholds is referenced in Health Canada's front-of-package labelling draft regulations and the forthcoming Canada Food Guide and should also be used, we say, to determine which foods may or may not be marketed to children, namely those with more than 15% of the recommended daily value of salt, sugar, and saturated fats.

Appropriate definitions of “high in” will also need to be developed for restaurants and other food service applications, recognizing that the DVs, daily values, should reflect the consumption of meals rather than of individual products.

The third recommendation is to revise item (ii) of proposed paragraph 30(1)(e.1) to read:

setting out factors to be considered in determining whether an advertisement is directed primarily at children, without unreasonably limiting access by an audience other than children to that advertisement;

The extra hurdle of adding the words “unreasonably limiting” is necessary to prevent regulatory overreach, which has already been evident in Health Canada's discussion document around determining whether an advertisement is primarily directed at children.

The last recommendation concerns the coming into force date. It leaves, as I said, no time to prepare or execute. The impact of Bill S-228 will be substantial, not only for marketers but also for the broadcast media, as well as the beneficiaries of sponsorships, as we've heard, not only for amateur sports and cultural and community-based events, but for such other things as the Calgary Stampede.

As such, we recommend that the coming into force date be amended to December 14, 2022, consistent with other parts of the healthy eating strategy.

You will note that none of these proposed amendments is in the least bit out of step or inconsistent with the intent of Bill S-228 . Consequently, we urge you to adopt them.

Moving on to other Health Canada and industry partnership solutions, we have several that we'd like to talk about.

The first one is to create a regulatory framework requiring pre-clearance of food and beverage advertising to children for digital advertising. Pre-clearance for broadcast advertising is mandatory, while digital advertising is voluntary. Moving to a mandatory pre-clearance of digital would reduce exposure to food and beverage ads to children and build upon the existing regulatory framework under the Broadcast Code for Advertising to Children.

We would recommend that Ad Standards provide the oversight, monitoring, and enforcement, of course in partnership with Health Canada.

Second, for broadcast advertising, “child-directed” should be redefined as advertising where children represent 25% or more of the audience. This represents a significant reduction from the voluntary 35% child audience threshold.

As noted, the time slot ban advocated by Health Canada would virtually ban all food and beverage advertising, including that directed to adults. Audience composition measurement promotes more precise audience targeting and would deliver on Bill S-228's objective without costly overreach and, I repeat for the third time, a charter challenge.

I'll move to the third point, developing a Canadian “best in class” regulatory framework for restricting digital marketing directed at kids. Advertisers are committed to mandatory pre-clearance of food and beverage advertising to children for foods and beverages below a 15% DV of saturated fat, sugar, and sodium at a campaign level, bringing it in line with broadcast. Foods above the 15% DV threshold would not be approved for digital advertising to kids.

Working with Health Canada and IAB Canada, we will develop the most effective ways to deliver a digital reach threshold ensuring that 75% of any campaign audience is 13 years of age or older. We would also implement rigorous record keeping to ensure that children under 13 are not being targeted and were not targeted through audits, random samples, and some other things that we're looking at.

The fourth recommendation would be enforcement. As with broadcast, media would not accept food and beverage ads directed at children unless they carry an Ad Standards clearance number. In cases of digital, compliance would require companies to report annually to Ad Standards on the placement of advertising. As I said, we're looking at some more technical solutions with IAB Canada. Ad Standards would investigate and report on any complaints from the public and stakeholders regarding alleged non-compliance.

For non-compliance, Ad Standards would admonish the advertiser to ensure that the issue is resolved and does not recur. Ad Standards would also publish annual compliance reports, identifying any non-compliant advertisers. Further enforcement, such as fines and criminal charges, would be administered through the regulation by CFIA.

In conclusion, I want to reiterate that we do in fact support the government's objective of reducing childhood obesity. To help achieve this point, our member companies have unique experience and insights to commit meaningful, multi-faceted, multi-stakeholder approaches to healthy eating and to the effective restriction of food and beverage marketing to children. We ask, however, that such strategies and measures be implemented without unnecessary regulatory overreach and economic harm from inadvertent prohibition of the lawful and constitutional right to market foods and beverages to adults.

To support this, we again urge that the aforementioned amendments be adopted by this committee.

Thank you.

[The Chair, Liberal, Bill Casey]

Thank you.

Now we go to Dr. Tom Warshawski from the Childhood Obesity Foundation.

[Dr. Tom Warshawski, Chair, Stop Marketing to Kids Coalition, Childhood Obesity Foundation]

Thanks, Mr. Casey.

Thanks for allowing the group to have a look at the graphs; otherwise, my talk won't make a lot of sense. Hopefully it will otherwise.

I'm Dr. Tom Warshawski. I'm a consultant pediatrician working in the trenches with children and youth in British Columbia. I'm also the chair of the Childhood Obesity Foundation and the chair of the Stop Marketing to Kids Coalition, which is a coalition of NGOs from across Canada. It represents all of the major health-oriented NGOs, including the Heart and Stroke Foundation, Dietitians of Canada, Diabetes Canada, Canadian Cancer Society, Food Secure Canada, and the Canadian Medical Association, all of which have come together over the last four or five years because we feel that this issue is so very important.

I'm going to make a few points and then go to the graphs so that I can show you graphically what this is all about.

The number one point I want to make is that an elevated BMI, or obesity, is strongly associated with adverse health outcomes. They range from type 2 diabetes to heart disease, cancer, stroke, and hypertension.

Almost all excessive weight gain is due to dietary factors. It's not an issue of inadequate physical activity. The food industry has attempted to deflect the issue to being one of inadequate exercise. That's simply not supported by the evidence.

The third thing I want to say is that the ill health associated with an elevated BMI is not due simply to the fat mass. Fat is a metabolically active tissue. It secretes cytokines, which have actions at distal organs, but irrespective of your body weight, if you're eating the wrong types of foods, you raise the risk of diabetes, heart disease, and cancer. It's not simply linked with obesity.

It's not that we have to worry only about that 30% of kids or that 60% of adults are overweight and obese. Food is very important, so much so that the global burden of disease estimates that diet-related disease now kills more Canadians than smoking. It's not that smoking is so much better, there's just less of it right now. Smoking is decreasing, and we have an increasing burden due to dietary factors.

Excessive weight gain in children and youth is important not just because of the long-term effects in adulthood, but it's important to children and youth in and of themselves. It's associated with joint problems from carrying this extra weight. It's associated with asthma. Those cytokines, which I talked about, that fat cells produce also work in the lung to trigger asthma and sleep apnea. Mental health issues, both bidirectional anxiety and depression, can cause overweight and obesity or are associated with it, but also, overweight and obesity cause those problems in children and youth.

We are seeing adverse metabolic effects, such as high blood lipids, hypertension, and impaired glucose regulation, in preschoolers who are overweight and obese. A study in Italy looking at overweight and obese preschoolers showed that one-third had some adverse metabolic effect.

When we look at Canadian data on children who are overweight and obese between the ages of 6 and 17, one-third or more had adverse metabolic effects. We are seeing an epidemic of the metabolic syndrome. Some 3% of Canadian adolescents have metabolic syndrome, which has lifelong ramifications. It can also affect cognition in adolescents.

These are big problems right here and now.

To illustrate the effects of poor diet, I'm going to show you the graph on growth charts. There are a couple of utilities there to show in the growth charts just how it's put in place or, when we talk about childhood obesity, what it means. It's defined by growth centile. We look at what the overweight range is for adults. A BMI between 25 to 30 is overweight; above 30 is obese.

If we look at this particular case of Zachary, whom I first saw at age 10 for his asthma, things are going relatively well. His parents divorced. Things did not go so well; diet went down the tubes. Dad was busy trying to manage everything. Mom left the province. He began to eat a lot of junk food.

What you see is that his height continued on its normal trajectory, because that's genetically endowed, and his weight began to go up, up, up. What you see on the next page is the dramatic increase in his BMI. This was not due to a lack of exercise. It was strictly due to what he was eating.

This isn't just Zachary. This represents 30% of children and youth across Canada.

I read the riot act to Zachary and his parents, and Zachary stormed out of the office in tears because I said he couldn't drink sugary drinks anymore—no juice, no pop, and no more processed foods. To their credit, they made these changes; his weight stabilized, and the BMI dropped. That's very hard for a family to do.

People say, “Well, isn't this the family's role?” When you look at families, in 60% of families, both parents are working, and 15% of families are run by single parents. In 15%, the parents have low literacy, and 15% are recent immigrants; 10% have low income; 10% have mental health issues. The average family, then, is struggling; they're just trying to get by. We cannot create a milieu in which these children and these families can be exploited.

What I also want to talk about is the fact that we know what constitute healthy and unhealthy foods. I have two diagrams that I want to show you. The one with the coloured arrows is from Mozaffarian, in Circulation. This is a compendium of best practices from 2016. The blue area shows the foods that are clearly beneficial in terms of cardiometabolic health, obesity, cancer, and hypertension. They are fruits, nuts, fish, vegetables, vegetable oils, whole grains, beans, and yogourt, almost none of which are advertised to anybody, never mind children and youth.

The ones that are clearly harmful or unhealthy are the refined grains, starches, sugars, processed meat, and high-sodium foods. Industrial trans fat will no longer be a problem because it's being expunged from the food supply. These foods are the ones that are heavily marketed to children and youth, and they are harmful. They're harmful now, and they're going to be harmful into the future.

It seems only reasonable that foods with clear benefits should be marketed to children and youth. Appendix 4 has data from Canada. This is from Mary L’Abbé's shop at the University of Toronto, which is looking at the association of various foods with obesity in Canadian adults. The issues are the same. The same foods are associated with overweight and obesity in adults, and it is the same foods that are preventing overweight and obesity. You should be eating the fruits, the vegetables, the yogourt, and the whole grains. You should be avoiding the fast foods, carbonated drinks, refined grains, solid fats, and processed meats, which are the ones that are being marketed to children and youth. They're also being marketed to adults.

This is the association. When you look at someone's overweight and obesity and ask them what they've eaten, you flip that around and you give dietary advice to people. If you can implement that advice, and if people take that advice, you get an improvement in weight status. A very recent study just came out in JAMA, in February 2018, from Charles Gardner at Stanford. With 600 adults, they were comparing a low-carb, high-fat diet to a high-carb, low-fat diet. In fact, they found that they were equally as effective as long as people ate healthy.

Eating healthy had four major components. One, cut out all the sugars: sugary drinks and foods with added sugars. In Canada, 66% of the processed food has added sugars. As well, cut out the processed foods and the refined grains. Also, diminish the fast-food intake. Last, cook and eat at home and increase the vegetable intake. When people could follow these rules, regardless of whether it was high fat or low fat, 75% lost weight. They improved their blood pressure and their metabolic parameters. A third of them went from having metabolic syndrome to no longer having metabolic syndrome.

We know what constitutes a healthy diet, and we know what Health Canada has to do to explain that with understandable daily values.

Other points I want to make are around the issue of children and children's vulnerability. It's intuitively obvious that someone under the age of five who believes in the Easter bunny can be manipulated by marketing. It's less intuitively obvious how manipulable or vulnerable teens are. Towards that end, I want to give you a three-minute talk on cognitive neuroscience. This is condensed, of course. It's appendix 5.

The part of the brain that's responsible for logical thought, for reasoning, is the prefrontal cortex. It develops in a slow, linear fashion from birth up until age 25. It's constantly evolving. As that's evolving, however, puberty intercedes. Those of us who have teenagers or who have been teenagers understand that very real behavioural changes occur. These are hard-wired changes. They are the result of the surge in testosterone and in estrogen, which cause brain changes.

What our diagram shows is the ventral striatum, the area at the base of the brain that is responsible for reward seeking and for discounting risks. That gets a huge surge in activity with puberty, which diminishes over time. That's why Red Bull has such a great appeal for kids and teens; when they see these guys sailing on their mountain bikes over these castles, they ask what could go wrong.

Another area that gets a big surge is the area of the amygdala and the hippocampus. These are the emotional centres. They actually grow in size with puberty. This has been documented by MRI. Associated with that is an increased role of emotion in decision-making. The beverage companies in particular...Coca-Cola is very good at tweaking those strings in their advertising. These ads are aimed at teens. They're not aimed at younger kids.

The other area that is important is that of the diffuse cortical changes in the temporal lobes. These are the areas responsible for social affiliation. There is a natural tendency for teens to shift their affiliation from their parents and adults to other teens. This type of behaviour goes across all mammalian species. It does have an evolutionary role, because it triggers the individual to seek novelty, to take risks, and to expand their territory.

What happens in these kids is really a control imbalance. If you look our last graph in appendix 6, what you see is a gradual increase in prefrontal cortex function, which is moving along merrily. That's why your 10-year-old thinks better than your five-year-old.

[The Chair, Liberal, Bill Casey]

Doctor, I need you to wind up pretty soon.

[Dr. Tom Warshawski]

Okay.

Puberty intercedes and, all of a sudden, risk-taking happens. If you wait it out, they'll get better.

The bottom line, I think, is that we know what has to be done. The government definitely has to move to protect children and youth in all age groups. From the coalition's perspective, we can understand the government taking a step to take a strategic retreat on the age limit, from 16 and under to under 13. This should be a strategic step.

Over the next few years, marketing to teens has to be monitored, and there have to be some meaningful steps to protect teens. In terms of sports sponsorship, we understand how vital it is for kids to be engaged in sports. Over the monitoring period, we would like to see the role of sports sponsorship being monitored and government looking at alternatives to sponsorship for these vital programs aside from the food industry.

I'll leave it there. Thank you.

[The Chair, Liberal, Bill Casey]

Thanks very much.

We're going to our first round of questions. These are seven-minute rounds.

I'm going to start with Mr. McKinnon.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Thank you, Chair.

I have a quick question, and then I will share the rest of my time with my colleague Dr. Fry.

My question is for the Canadian advertisers.

You've painted a pretty dark picture of the devastated advertising landscape that will ensue if this bill is passed and of cascading government revenues, and so forth. It sounds like there are no products that are not harmful to kids that would be marketed in these time periods. Is that true? Are there not products out there that people will want to advertise to get kids to ask their parents to buy for them in order to help fill in the advertising slots in those time frames?

[Ronald Lund]

Our devastation isn't coming from the lack of advertising to kids. We're in fact supportive of restrictions of high-end foods to children. What we're worried about is the way the legislation is being dovetailed with what's come out of Health Canada in their document: it would actually affect adult advertising.

Let me give you an example of that. I've talked about the ban thresholds. One of the ban thresholds is from 3 p.m. until 9 p.m. The Keg—I don't think anyone here would think they're advertising to children, and that's why I choose to use that as an example—will have a steak with a fully baked potato with sour cream, etc. This clearly is going to be high in saturated fats, quite likely, and maybe even in sodium. At night, at 8 or 8:30 p.m., airing that would not be allowed. They will see a beer ad, but they will not see that food ad at the current trajectory of the two pieces of work that are dovetailing. As for our concern, the devastation doesn't come from the lack of advertising to children: it comes from the ability to target adults.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

It seems hard for me to see that an ad advertising a baked potato is going to appeal to a child or that it is going to be seen as being directed at a child.

[Ronald Lund]

That's where the legislation is taking it, though. That's why we're concerned about that.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

I see.

Thank you.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thanks very much, Ron, for sharing your time with me.

It seems to me I've heard this song before. I'm addressing this to advertising and to sports. I was around this block when cigarettes were being advertised and promoted at all the festivals, at jazz and sports and everything. People said, “Gee whiz, we're never going to get any money once you cut this.” But we did it because we knew that just like drinking a beverage that's high in sugar, there's only one way to drink that beverage. Cigarettes were very harmful because if you use them as directed, you will get sick. We had to target cigarettes.

Eventually, the government phased out advertising and phased out promotion in some of the important arenas like sport. I'm not saying you don't need the money and the sponsorship. But we actually moved it, and the government played a role in helping to do some sponsorship. Today no one talks about the lack of tobacco advertising and promotion.

I heard a sports group talk about restaurants. Obviously, restaurants have options. They can promote healthy food. Restaurants may have an incentive to start talking about salads, to start talking about greens and fruit, lower sodium in some of their foods, low-fat milk, and so on. That's possible. I see no reason that we cannot look at how we set guidelines for restaurants. They actually can target and can advertise. I've seen that change happening in restaurants like McDonald's and Tim Hortons. People are looking at healthier alternatives. When we talk about the beverages, I don't see any alternative. No matter how you spin it, if you start using pop, it will increase type 2 diabetes. We know that the sugars are terrible. Even by advertising and telling kids that it's okay if they drink Coke Zero or Diet Coke or whatever.... We know that's not actually true.

Basically, then, I do think this could be seen as not a negative thing—I hear you about the timelines, and I hope those things are negotiable in terms of adult advertising times—but it could be seen as an incentive for restaurants, fast-food restaurants, beverages, and other products that are being sold today to start changing their menus and changing the way they produce their product. Why is it that a small carton of yogourt, which is good for you, contains 15 to 25 grams of sugar? Why? We know that sugar is addictive. Once children get sugar at a very early age, they crave sugar from then on. Adults do too.

Let's look at what this benefit is. You talked about jobs and about how taxes to the government, etc., would be diminished. I'm saying to you that the government already carries the can for all the type 2 diabetes, all the cardiac disease, all the high blood pressure, all the kidney disease. Those are health costs to the government, so it is in the government's best interest, and in the best interest of citizens, to move in this direction.

I'm using tobacco as a good example of how you could move forward without denying the sponsorship abilities of other people to come in and take their place. It is an incentive, I think, for menus, restaurants, and products and beverages to start looking at what they are marketing and the amount of sugar, etc., in their products. I do not think Red Bull should be targeted to children at all. We looked at this in the health committee a few years ago. We've had incidents of children dying because of having two or three Red Bulls on a hot day and having all that caffeine and all that effect on their hearts.

I just wanted to say that I hear you, but I think we should flip this and look at it from a positive perspective and at what can happen for the sports groups, etc., with changing sponsorship and having other people step in with healthier alternatives.

Thank you.

[The Chair, Liberal, Bill Casey]

Does anybody have an answer in three seconds?

[Lindsay Hugenholtz Sherk]

I would appreciate the opportunity to respond on the tobacco, but it wouldn't take three seconds.

[The Chair, Liberal, Bill Casey]

Just do your best.

[Lindsay Hugenholtz Sherk]

I actually have some specific speaking points. I appreciate your raising tobacco, because there are a lot of misconceptions about how tobacco impacted sports sponsorship.

To begin, I think it's interesting that neither Erica nor I—Erica is a millennial and I come from generation X—have any recollection of tobacco sponsoring amateur sport. We were both under the age of 17 and at that impressionable age and stage when tobacco sponsorship was at its peak, and then it was phased out in the early 1990s.

Through my research and speaking with experts in the area of sports sponsorship, I've learned that community sport and very few national sport organizations benefited from tobacco sponsorship. Tobacco primarily sponsored car racing, professional golf, and professional tennis.

I would also like to offer that the world of sponsorship today is far more sophisticated compared to sponsorship back in the 1980s and 1990s when tobacco was relying primarily on advertising billboards and signage throughout the venues. Today, sports sponsors are focused on experiential activation through social media, creating personalized experiences, and using the latest digital solutions to attract more customers to their brand and increase subscribers.

My last point is that there is no comparison between the tobacco sponsorship back in the 1980s and 1990s and today's reality. If food and beverage companies were no longer permitted to invest in sport today, over 470,000 children participating in Hockey Canada programs and 475,000 children participating in Canada Soccer programs would be impacted. We believe the impact would result in either cancellation of these programs, because they would be cost prohibitive to Hockey Canada and Canada Soccer, or fewer children and youth being able to afford to participate in these programs.

[The Chair, Liberal, Bill Casey]

Thanks very much.

Now we go to Mr. Webber.