Health Committee on Feb. 14th, 2023

[Elio Antunes]

I can start, but I certainly can't talk to the—

[Dr. Tom Warshawski]

I can speak to that, Adam.

It's Dr. Tom Warshawski from the Childhood Obesity Foundation. I'm a pediatrician who actively treats children who are overweight and obese.

You are right that the trajectory begins early in childhood. The major driver for excess weight gain is dietary, and that is affected by socio-economic status.

Again I would say that all governments have to be especially careful with their funding. Low-hanging fruit is to restrict the marketing and restrict the appeal of these unhealthy foods and beverages to kids, but then also to optimize their ability to be physically active and to allow them to consume healthy food and develop preferences for it, as Ms. Webb said.

It is very important to begin early. I think, though, that the major driver for excess weight gain is the food that we eat. The American guidelines reflect American reality in terms of the politics. They will not implement widespread policies, such as restricting the marketing of unhealthy foods and beverages to kids; they are focused on individual behavioural choices. That's the first part of their guidelines. Then they step up to medications and then finally to bariatric surgery.

In Canada we have a unique opportunity. As I said, we are poised to implement a unique opportunity to diminish the role of marketing and diminish the appeal of the unhealthy foods and beverages that are driving, in part, the obesity epidemic.

[Adam van Koeverden, Liberal, Milton, ON]

Thank you, Doctor.

As you are undoubtedly aware, our colleague Patricia Lattanzio currently has her private member's bill referred to this committee, and we look forward to studying it.

We know the industry has made some attempts at self-regulation around unhealthy foods and marketing to children. However, it's said these voluntary codes are not effective. Very briefly—to leave me a bit of time at the end to talk about physical activity—could you tell me why those self-regulatory attempts are not effective?

[Dr. Tom Warshawski]

Well, it's a voluntary code. In fact, when this issue was studied by Monique Potvin Kent about seven years ago, the companies that had not signed the voluntary code did less advertising than those that had.

One of the primary reasons that the new code being introduced next year won't be effective is that there are huge loopholes in how they can advertise. The example I gave was Lucky Charms, which is probably one of the most egregious examples of ultra-processed food. It's sugar with food dyes pressed into appealing shapes. This particular product would be allowed to be directly advertised to children through spokespersons, cartoon characters, etc.

Although there are a few good elements in the guidelines, there are so many loopholes that they won't be effective.

[Adam van Koeverden, Liberal, Milton, ON]

Thank you, Doctor.

I'll focus the rest of my time on the Community Sport for All initiative, which both the Participaction and Canadian Tire Jumpstart organizations mentioned.

This was an initiative brought forward by our government to restimulate interest in, availability of and access to community sport programming across the country. It was actually quite novel. No federal government has invested that much money in community sport programming. It's generally seen as a provincial and municipal priority, but the stark numbers coming from both Participaction and Canadian Tire Jumpstart—the research you did, along with the Canadian Women and Sport organization—were frankly too troubling to ignore.

Could you speak to some of the initiatives you're able to fund through these envelopes?

[Elio Antunes]

I can start.

We're funding initiatives associated with our June community challenge, which is mobilizing community organizations to offer accessible sport and physical activity programming to local organizations. We've been able to target organizations primarily in the sport and physical activity sector. We want to broaden their outreach and engage equity-deserving groups in their programs.

We have also reached out to groups that represent equity-deserving groups and have made those connections with programming in their community, which they might not otherwise have access to or be aware of. We funded them so they can put in programs that connect back to the communities.

I think it's been a significant success, and much needed. It's an opportunity for us to be very targeted in our approach, address the barriers those organizations face, and be very customized in the way we deliver those programs.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Antunes.

I will now turn the floor over to Mr. Garon for six minutes.

[Jean-Denis Garon, Bloc, Mirabel, QC]

Thank you, Mr. Chairman.

I thank all of our guests for being here today.

My question is for Dr. Warshawski.

In 2017, the federal government conducted a public consultation on children and junk food. Since the government has yet to introduce legislation, including on advertising to children under 13 regarding junk food, I would guess that the findings of this consultation were negative and that this is not an important issue for Canadians.

Do we have the results of that consultation?

[Dr. Tom Warshawski]

I think it's important. Polling has indicated that between 75% to 80% of parents want to see restrictions on the marketing of unhealthy foods and beverages to children. The government back in 2015 tried to get this moving. Conservative Senator Nancy Greene Raine introduced a private member's bill to the Senate—Bill S-228—that had very strong support in the House of Commons. It initially had unanimous support in the Senate and wound its way back to the Senate in 2019, but then died on the order paper. It was filibustered by certain senators and died.

That is one of the concerns we have as government waits for Bill C-252 to wind its way through Parliament. We think it could very likely suffer the same fate as Bill S-228 and die in the Senate. We think it's important that this bill be allowed to go through. Hopefully it will pass, but a parallel track would be for government to implement the regulations I mentioned in the Canada Gazette.

[Jean-Denis Garon, Bloc, Mirabel, QC]

Thank you, Doctor.

This is what I was trying to say. On the one hand, Liberal MPs and ministers start consultations saying that it is important to protect children from junk food, and on the other hand, private members' bills are allowed to die on the order paper. Yet the Minister of Health himself has never made the effort to introduce a bill in this regard.

You put your finger on exactly the problem. They say health care is important, but when it is time for the government to act, it never is.

Some members will state in the House that the free market works, that we do not need to intervene and that advertising disseminates information to children. They suggest that an 11‑year‑old is able to tell the difference between advertising content and information that is accurate.

Are children able to distinguish misleading advertising from accurate information?

[Dr. Tom Warshawski]

The short answer is no.

Under the age of five, kids cannot distinguish advertising from content. Even under the age of 12, they don't really understand the persuasive nature of the advertising. Advertising is getting more sophisticated.

A recent report came out of the Heart and Stroke Foundation about social media and social media user-generated ads. These are young people basically advertising to other young people, which is even more surreptitious. Yes, children have a very hard time recognizing advertising.

From my perspective, as someone who's worked at this since 2014, many areas of government at the federal level have worked towards getting effective restrictions on the marketing of unhealthy foods and beverages to kids, and they were somewhat blindsided in 2019 when it died in the Senate. I just don't want to see us repeat the same mistake now. I do not want to see us putting all our eggs in one basket with Bill C-252. The regulatory process through the Canada Gazette needs to go forward on a parallel track, and if they can converge on a common destination, that would be great. If not, then we have the regulations in hand.

[Jean-Denis Garon, Bloc, Mirabel, QC]

Thank you.

The legislative process will possibly lead us to the passage of this bill, and it is not the first time such an attempt has been made. Yet food processing is a multi-billion-dollar industry. I'm not painting the entire agri-food industry with the same brush. Some farmers make excellent products, and the stakes are high for them. That said, some people are selling junk food to our children.

This industry can be very intense in lobbying some members of Congress to thwart any effort to pass a bill in the House that promotes better health for our children. Are you concerned about that?

[Dr. Tom Warshawski]

I'm not “worried”; I'm sure that they will. It was effective in killing Bill S-228 in the Senate.

However, I believe that the civil servants in Health Canada recognize the data. I think that most parties in the House of Commons recognize the importance of this bill. I believe that government has the necessary information and desire to move these issues forward.

[Jean-Denis Garon, Bloc, Mirabel, QC]

Thank you.

I only have 40 seconds left.

Within its jurisdiction, Quebec already has a law in place that protects children under the age of 13 from advertising aimed at them. Several scientific articles show that, on average, Quebec children eat better than the average Canadian child.

Do you think this law may have had something to do with it?

[Dr. Tom Warshawski]

Absolutely.

[Jean-Denis Garon, Bloc, Mirabel, QC]

That's the kind of answer I like.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Garon.

Next we have Mr. Davies, please, for six minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair, and thank you to all the witnesses for being here.

Dr. Warshawski, how is “childhood obesity” defined?

[Dr. Tom Warshawski]

Childhood obesity is defined according to curves generated by the World Health Organization. It's a little bit complicated. It's actually reasoning backward or extrapolating backward from those BMI criteria that in adulthood—say, above the age of 19 years—are associated with an increased risk of chronic diseases and higher rates of mortality. Reasoning backward or extrapolating backward from those curve points, “overweight” in adults is defined as a BMI above 25, or 25 to 30, and “obesity” is above 30.

Reasoning backwards on these growth curves, we can see that if a child's above the 85th percentile for their BMI at a given age, they're categorized as overweight. If they're above the 97th percentile, they're categorized as being obese.

[Don Davies, NDP, Vancouver Kingsway, BC]

From my reading of the literature investigating obesity stigma, most of that is focused on adults living with obesity. How does obesity stigma affect children and their families?

[Dr. Tom Warshawski]

It affects them quite severely, actually. In a study that's now 10 years old or older, children living with obesity rate the quality of their lives lower than children who are undergoing chemotherapy for cancer.

Stigma against obesity—bias against obesity—is one of the last publicly acceptable prejudices. That status of being overweight or obese is erroneously linked with gluttony, sloth and self-indulgence, whereas in fact it's a confluence of genetics and the obesogenic environment we have.

In my practice, I have many children who have cried when they're placed on the scale just so I can get their BMI. They are extremely self-conscious about their weight. They're getting teased in class relentlessly. This sort of state is linked with depression and anxiety in children.

[Don Davies, NDP, Vancouver Kingsway, BC]

Anecdotally, I think we all think and see that there's greater obesity in children today than there was in the past. Can you give us a bit of math around that, about the trajectory? Is childhood obesity increasing?

[Dr. Tom Warshawski]

Yes. Back in 1978, the incidence of child obesity was around 6%. Now it's around 12%. It has increased significantly. It's doubled. The incidence of total overweight and obesity was around 23%. Now it's at 31%.

It actually seemed to peak around 2004. We've had a slight drop in the levels of overweight and obesity. That may be in part due to better regulations in schools around the marketing of unhealthy foods and beverages to kids and sales of these products. We've also seen the sales of sugary drinks dropping a bit in the last decade or so.

However, the overall numbers are still quite significant, and they need to be addressed.

[Don Davies, NDP, Vancouver Kingsway, BC]

Can you outline the impact that sugary beverage taxes have had on childhood obesity in jurisdictions that have implemented them to date? Would it be your recommendation that Canada implement such a tax?

[Dr. Tom Warshawski]

Taxes on sugar-sweetened beverages are an effective policy lever to decrease the purchase and consumption of products. I think the evidence is quite strong from jurisdictions in the States in different municipalities that have introduced them, and from Mexico.

To actually see the change in the rate of overweight and obesity is something that's going to be downstream. It's going to take probably five to 10 years to see this, but short-term studies in adolescents show that reducing the intake of sugar-sweetened beverages is important.

In terms of a policy lever, it is something that the federal government I think should consider. It wasn't the focus of my conversation today because, again, I think we are shovel-ready for restricting the marketing of unhealthy foods and beverages to kids.

Interestingly enough, Newfoundland has just introduced a particular tax on sugary drinks. I believe that came into place in September.

It's going to take a while to see how this unfolds, but one of the reasons or rationales to have a tax is to generate income to help fund programs such as school nutrition programs. When I appear before this committee, I realize and I think we all realize that government has lots of asks and only a limited budget, and there's only one taxpayer. When we think about putting in new programs with costs, we also have to think about how it could be funded. A tax on sugary drinks would be a great way to fund these types of nutrition programs.