Status of Women Committee on Dec. 10th, 2013

[The Chair, NDP, Hélène LeBlanc]

Good afternoon, and welcome to the eighth meeting of the Standing Committee on the Status of Women. The topic we are considering today concerns eating disorders amongst girls and women.

The meeting will be conducted as follows. Each department or organization will have a maximum of 10 minutes to make its presentation and then we will move on to the questions. I would like to inform you that representatives from Status of Women Canada will be here to answer our questions after the presentations of other witnesses.

I welcome all the witnesses who took the time to meet with us to give us some insight on this very important topic. Today we have the following witnesses: from Status of Women Canada, Sébastien Goupil, Director General, Policy and External Relations, and Linda Savoie, Director General, Women's Program and Regional Operations; from the Department of Health, Hasan Hutchinson, Director General, Office of Nutrition Policy and Promotion, Health Products and Food Branch; and from the Public Health Agency of Canada, Marla Israel, Acting Director General, Centre for Health Promotion, Health Promotion and Chronic Disease Branch. Lastly, via videoconference, I would like to welcome Joy Johnson, from the Canadian Institutes of Health Research, who is Scientific Director for the Institute of Gender and Health.

Ms. Israel, you may begin your presentation. You have 10 minutes.

[Marla Israel, Acting Director General, Centre for Health Promotion, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada]

Thank you very much, Madam Chair and members of the committee.

Members of the committee, thank you so much for the opportunity to speak with you today on the subject of eating disorders. My remarks today will focus on the activities of the Public Health Agency of Canada related to this issue.

The Public Health Agency of Canada is committed to improving the health and well-being of Canadians. We do so by administering programs and developing policies that serve to promote the physical and mental health of Canadians and prevent illness. The agency works to reduce risk factors that may contribute to poor health, such as abuse, violence, or neglect, while building such protective factors as resilience, esteem, coping skills, and healthier relationships.

Eating disorders involve serious disturbances in eating behaviour. Some disorders, such as anorexia, bulimia and binge eating are mental illnesses that may be associated with stigmatization, isolation and low self-esteem.

Risk factors associated with eating disorders include a combination of biological, psychosocial and social factors as well as developmental factors particularly associated with pressures to be thin, inadequate coping mechanisms, neglect and overprotection.

The release of the 2006 Senate report “Out of the Shadows at Last” brought the issue of mental illness into the mainstream and contributed to the creation of the Mental Health Commission of Canada in 2007. The release of the Mental Health Commission's mental health strategy for Canada identified six strategic directions to improve the continuum of mental health for Canadians. The first strategic direction is to promote the mental well-being of Canadians across the lifespan in homes, schools, and workplaces and prevent mental illness and suicide wherever possible.

Promoting mental health and well-being is about enhancing the capacity of communities and individuals to take control over their lives and improve their mental health. It's about increasing their power and resilience to respond to future adversities. For this reason, our programs focus on populations at highest risk, such as vulnerable children and their families.

From a public health perspective, the prevention of eating disorders begins with a solid foundation in terms of mental well-being. I am talking specifically about establishing healthy relationships, fostering sound parenting skills, learning good strategies to overcome adversity, and building positive self-esteem and self-confidence.

We know that initiatives that focus on people's early years and target their environment as a whole are more likely to protect them from poor mental health and mental illness later in life.

To help build this foundation, the Public Health Agency of Canada is supporting programs and activities to maintain and enhance mental well-being. We deliver programs focused on creating a better start in life for vulnerable at-risk children and their families. These programs provide parenting skills and the tools to develop healthy relationships in order to address challenges they may encounter. The agency also plays a key role in surveillance to better understand the factors that influence the physical and mental health of Canadians. These include child abuse and neglect, childhood injuries, self-harm, and mental illness, including eating disorders.

In 2006 we reported that 0.5% of Canadians aged 15 years and over had been diagnosed with an eating disorder in the previous 12 months and that 1.5% of Canadians aged 15 years and older reported symptoms that met the criteria for an eating attitude problem. This information is critical to better understand the rates and prevalence of illness and to better inform the development of policies and programs.

The agency also supports projects that promote healthier behaviours through positive attitudes and physical activity, and we work closely with our colleagues at Health Canada to support healthier eating.

Many factors impact our day-to-day physical and mental health—where we live, where we work, and relationships with our friends, families, and communities. These factors, alone or in combination, have a tremendous impact on how we feel and what we do.

Our goal is to prevent or lessen the impact of mental illness and poor mental health among Canadians. We want to support girls and boys in growing up with a positive sense of self, with feelings of control and self-esteem. This foundation can help protect against developing an eating disorder.

The Public Health Agency of Canada is committed to improving the overall health and well-being of all Canadians. Strengthening and maintaining our mental and physical health will help us limit the devastating effects of mental illness, including the impact of eating disorders among young girls, boys, women and men.

Thank you.

[Dr. Hasan Hutchinson, Director General, Office of Nutrition Policy and Promotion, Health Products and Food Branch, Department of Health]

Thank you, Madam Chair and members of the committee. I am pleased to be here today with my colleagues from the Public Health Agency of Canada, Canadian Institutes of Health Research, and Status of Women Canada.

We recognize that eating disorders are a very worrisome mental health problem. Today I will talk about Health Canada's healthy eating initiatives. While these initiatives do not directly address eating disorders, they are specifically designed and implemented to minimize unforeseen and adverse consequences, such as encouraging poor eating habits.

Healthy eating plays an important role in promoting health and reducing the risk of nutrition-related chronic diseases. Health Canada has a national leadership role to play in supporting healthy eating through the development of nutrition policies and guidelines, enhancing the evidence base to support policy decisions, monitoring and reporting on what Canadians are eating, and providing Canadians with information through awareness and education initiatives that help them make informed and healthy eating decisions.

While developing national nutrition policies and health promotion initiatives, we work to ensure that there are no unintended negative consequences. Every effort is made to provide consumers with positive nutrition messages that focus on health and well-being, and not on weight, as weight preoccupation is a hallmark of eating disorders like anorexia nervosa and bulimia nervosa.

I'll provide a few examples of Health Canada's healthy eating initiatives that put the focus on health and not weight.

“Eating Well with Canada's Food Guide” is likely the most well-known national nutrition resource developed by Health Canada. The food guide promotes a pattern of eating that will meet nutrition needs, promote health, and minimize the risk of nutrition-related chronic diseases. It is designed to help explain to Canadians what healthy eating means. It is an important tool that underpins nutrition and health policies and standards across the country and serves as a basis for a wide variety of nutrition initiatives.

In the development of Canada's food guide, energy balance was of course a key consideration in the development of the food intake pattern, especially in light of the rising rates of obesity among Canadians. Despite this, though, Health Canada did not support a focus on calorie counting in the development of the food guide. Our approach was supported by many other public health stakeholders as well.

In 2011 the FPT Ministers of Health endorsed actions taken and future directions of the framework document “Curbing Childhood Obesity: A Federal, Provincial and Territorial Framework for Action to Promote Healthy Weights ”. While the framework is a call to reduce childhood obesity, not one of its 10 recommended actions promotes or supports weight-loss diets, calorie counting, or other weight-focused efforts.

Health Canada's healthy eating awareness and education initiative provides clear and consistent healthy eating messages for Canadians. Early phases of the campaign promoted better understanding of nutrition labelling. While the current phase of this healthy eating initiative is aimed at supporting healthy weights, the public messages and media focus encourage healthy eating habits, particularly through the development of food skills. The emphasis on food skills, not body weight, was very intentional.

Let me conclude by stating once again that eating disorders are a serious mental health disorder. Nutrition promotion policies, programs, and messages such as those developed by Health Canada, which focus on health and well-being and not on weight and calories, play an important role in the prevention of disordered eating.

So concludes my presentation, Madam Chair. I will gladly answer any questions committee members might have.

[The Chair, NDP, Hélène LeBlanc]

Thank you, Mr. Hutchinson.

Dr. Johnson, you have 10 minutes for your presentation.

[Dr. Joy Johnson, Scientific Director, Institute of Gender and Health, Canadian Institutes of Health Research]

Thank you very much, Madam Chair, and honourable members of the committee.

I'd like to thank you for inviting me to discuss the issue of eating disorders among girls and women.

As the scientific director of the Institute of Gender and Health, one of 13 institutes of the Canadian Institutes of Health Research, I'm pleased to have the opportunity to discuss with you how the Government of Canada, through CIHR, is contributing to advancing research knowledge and capacity-building in this area.

Eating disorders are a complex and multi-faceted health challenge. The spectrum of eating disorders varies widely, ranging from mildly abnormal eating habits to life-threatening chronic conditions. Women and girls, particularly young women, are at high risk, and tend to be more affected by eating disorders such as anorexia and bulimia, though an increasing number of boys and men are presenting with these conditions. For example, in one large United States study of children aged 9 to 14, 13.4% of girls and 7.1 % of boys displayed disordered eating behaviours. Young women aged 15 to 19 have the highest incidence rates of anorexia nervosa. The incidence of this condition has increased over time.

The causes of eating disorders are complex and highly gender-specific. They arise from the interactions of environmental context, biology, and developmental features. Risk factors include a family history of eating disorders, obesity, and mood disorders; and a past history of abuse, particularly sexual abuse. Girls who experience early puberty or who are obese are at increased risk for developing eating disorders.

Disordered eating causes medical and psychological challenges. Some of the medical consequences of eating disorders are irreversible or have later repercussions, particularly those affecting the skeleton, the reproductive system, and the brain.

A recent review of the scientific literature on eating disorders noted that anorexia nervosa has the highest mortality rate of all mental disorders. The same study stated that women with anorexia nervosa are 12 times more likely to die than age-matched women without anorexia nervosa in the general population.

Researchers and clinicians are making progress in understanding how to treat eating disorders. Nevertheless, persistent challenges remain in addressing this complex health issue that disproportionately affects Canadian women and girls.

It's the mission of CIHR to support the development and application of the research evidence needed to address challenges such as these. CIHR was established in 2000 by Parliament in recognition that investments in health and the health care system are part of the Canadian vision of being a caring society. CIHR's objectives are to excel, according to internationally accepted standards of scientific excellence, in the creation of new knowledge, and also to translate new knowledge into improved health for Canadians and more effective health services and products.

In 2012-13 the Government of Canada invested close to $1 billion to support the work of CIHR. Approximately 95% of this investment, or $940 million, was used to support more than 13,000 of the best researchers and trainees across the country through research grants and awards.

CIHR integrates research through a unique interdisciplinary structure made up of 13 virtual institutes. Several of these institutes support research related to eating disorders among girls and women.

CIHR's Institute of Neurosciences, Mental Health and Addiction supports research to enhance mental health through prevention strategies, screening, diagnosis, treatment, support, and palliation.

The Institute of Nutrition, Metabolism and Diabetes supports research to enhance health in relation to diet. One of its four research priorities is food and health.

CIHR's Institute of Human Development, Child and Youth Health has as one of its research priorities the development and mental health of children and youth.

And CIHR's Institute of Gender and Health, for which I am scientific director, supports research aimed at advancing our understanding of how gender and sex influence the health of women and men throughout life.

One of CIHR's key signature initiatives is the Strategy for Patient-Oriented Research. The primary objective of this major initiative is to foster evidence-informed health care by bringing innovative diagnostic and therapeutic approaches to the point of care. Through SPOR, CIHR is supporting research networks that are bringing together stakeholders from different sectors to generate evidence and innovations that advance practice and policy changes, leading to transformative and measurable improvements in health care.

The first SPOR network supported by CIHR is in the area of youth and adolescent mental health. It aims to improve the care provided to young Canadians with mental illness by translating promising research findings into practice and policy. This network represents an investment of $25 million over five years, equally shared by CIHR and the Graham Boeckh Foundation, and is aimed at developing clinical solutions to the mental health challenges faced by Canadian young people.

Through strategic investments and its investigator initiated programs, CIHR has directly funded $4.5 million in eating disorders research since 2006. In 2012-13, CIHR also funded $56 million in mental health research and $40 million in research related to nutrition. A few examples: CIHR funded research on the connections between substance abuse and eating disorders, the genetic determinants of low body weight in anorexia nervosa, long-term trends in relapse and recovery of women with anorexia, how relationships with fathers affect the development of eating disorders among young people, and methods for screening eating disorders among children and youth.

CIHR has supported researchers interested in understanding the effectiveness of web-based dissemination of best practice models to clinicians caring for patients with eating disorders and the effectiveness of treatment interventions for women with binge eating disorders. CIHR is proud to support groundbreaking Canadian research on eating disorders. This research holds an important key to addressing the challenge of eating disorders among girls and women.

Thank you very much for your attention.

[The Chair, NDP, Hélène LeBlanc]

Thank you, Dr. Johnson.

We will begin questions with Mrs. Truppe. You have seven minutes.

[Susan Truppe, Conservative, London North Centre, ON]

Thank you, Madam Chair.

I'd like to thank everyone for being with us today. It's a very important study and we're looking forward to moving on with this. I'm sure we'll all have some good questions.

Dr. Johnson, I have a couple for you. The work we're hearing about today involves partnerships and working across several disciplines and you've expressed there are many facets to tackle with the problem of eating disorders. You said there are some societal factions, genetic issues, and psychological components. Could you tell us about some of the partnership initiatives you support and why you support them?

[Dr. Joy Johnson]

At CIHR, a number of teams have been supported to specifically investigate eating disorders. For example, at the Douglas Institute in Montreal there's a multidisciplinary team that involves geneticists, psychologists, physicians, all joining together to address the issue of eating disorders. Clearly, this is an interdisciplinary issue. We need many minds coming together on this topic, and that's simply one example.

At the University of Ottawa, there's an excellent program related to eating disorders that's received CIHR funding, again multidisciplinary in nature, involving medical, psychological, and other health practitioners trying to come up with solutions and implement them in trying to address the issues related to eating disorders.

[Susan Truppe, Conservative, London North Centre, ON]

Thank you.

What are some of the partnerships you'd like to see or how do you think something else, like another partnership, might be helpful?

[Dr. Joy Johnson]

In addition to having researchers partnered together, ideally—and we're seeing more of this—the health portfolio is partnering together. We're finding ways that we can link up, join up the programming being offered by Health Canada and the Public Health Agency with researchers who are interested in investigating and understanding the implementation of programming.

We see a similar model, for example, with the Strategy for Patient-Oriented Research. We're partnering with provinces, trying to address a variety of issues related to taking research and moving it into practice, and from that standpoint I think really effectively beginning to address pressing issues related to primary health care, for example.

[Susan Truppe, Conservative, London North Centre, ON]

Thank you.

You also mentioned that the Government of Canada invested about $1 billion to support the work of CIHR, and 95% of the investment was used for researchers and trainees across the country. What was the other 5% for? Where is that used?

[Dr. Joy Johnson]

Yes, I can give you more specifics, more details about that, but that's basically the running of the organization, the other 5%.

[Susan Truppe, Conservative, London North Centre, ON]

I think there was one—

[Dr. Joy Johnson]

I think the important point here is that the majority of the dollars are going out to researchers to actually address pressing health issues for Canadians.

[Susan Truppe, Conservative, London North Centre, ON]

That's a lot of money. It's very good that the research is being done.

You also mentioned, I think a little later on, that CIHR had funded $4.5 million in eating disorders research since 2006 and then $56 million in mental health research and $40 million in research related to nutrition. Are any of these projects meant to be preventive, or maybe you can just elaborate a little bit on those ones?

[Dr. Joy Johnson]

Yes. As you've heard from my colleagues, we hear people talking about the issue of eating disorders in terms of a wide variety of determinants: mental health determinants, obesity as a determinant of eating disorders. We've also heard about, for example, sexual abuse. So, a number of the research initiatives we funded at CIHR have addressed these uphill determinants. We've funded, for example, a lot of work in the area of violence and abuse. We've funded a lot of work in the area of improving mental health of Canadians. From that standpoint, absolutely, research has been funded, and it's been quite promising in terms of addressing some of the important determinants that might lead to disordered eating.

[Susan Truppe, Conservative, London North Centre, ON]

Great, thank you very much.

My next question is for Ms. Israel. Thank you for your presentation also about public health and the role in helping identify and defeat eating disorders.

You mentioned that the agency's approach is to look at the mental health aspect of eating disorders through the program's at-risk individuals. Could you give us an example of some of the programs that are designed to maintain and increase mental health and well-being?

[Marla Israel]

One of the most important things that the agency undertakes is programs for at-risk children and their parents. One of the things that actually struck me when I was preparing for this committee was in looking at levels of income of people who have reported eating disorders. I was really struck that, of those who presented with eating disorders, at least 61% are reporting income in the lowest percentile. I think there's a misnomer that people assume that those who suffer with eating disorders—and I heard it at this committee—are those in the highest income brackets.

Some of the projects we're undertaking are, for example, the community action program for children, aboriginal head start in urban and northern communities, and the Canadian prenatal nutrition program. On an annual basis, those investments are around $115 million. We support community-based projects for ages zero to six and also, in aboriginal head start, ages three to five. We're looking at giving those at-risk children and their parents the greatest start they can get in life, as best as possible. To look at early childhood development, to look at better mental health promotion, to understand anger and aggression, and to foster more positive parenting; those are the focuses of those programs, as well as nutrition and good nutrition practice. Again, the issues around preventing abuse, preventing violence, and preventing anger are things that are very tangible.

I hope that answers your question.

[Susan Truppe, Conservative, London North Centre, ON]

Thank you.

You had mentioned also—am I done? That was a fast seven minutes.

[The Chair, NDP, Hélène LeBlanc]

You had 30 seconds. I didn't want to cheat you from your 30 seconds. Thank you very much.

Ms. Ashton, you have seven minutes.

[Niki Ashton, NDP, Churchill, MB]

Yes, thank you.

Thank you to all of our witnesses who are here today.

I'd like to start with Health Canada. We're hearing from witnesses that there's no formal place for eating disorders within the federal government. Of course, given that fact, we are extremely concerned because eating disorders have an extremely high mortality rate. Yet it seems they fall into a category where they receive no dedicated support from Health Canada. Using the example of another disease with a very high mortality rate—we heard the example of prostate cancer from a specialist in eating disorders, or even heart disease—I'm wondering if you can describe how Health Canada can direct funds and resources into research and treatment of a specific disease or disorder?

[Dr. Hasan Hutchinson]

Certainly the mandate we have with respect to healthy eating is more in the sense of making sure that Canadians understand what constitutes a good healthy pattern of eating, helping them make those choices, and helping them develop the skills to get there. The group I'm associated with doesn't have research funding per se that is targeted directly towards especially disease-specific endeavours.

When there are those diseases that have at their basis diet behaviours that are affecting them, we do, however, work very closely, as we mentioned before, across a portfolio with CIHR and with the Public Health Agency to try to make sure that our priorities come together. Dr. Johnson mentioned that we work very closely with the Institute of Nutrition, Metabolism and Diabetes to identify areas of research that have an impact on how Canadians make their decisions about healthy eating patterns.

[Niki Ashton, NDP, Churchill, MB]

We've obviously heard from CIHR on their work focused in that area. I know Health Canada is involved in research. Do you think it would be important to have dedicated funding for research under Health Canada when it comes to eating disorders?

[Dr. Hasan Hutchinson]

Again, the way we're set up is that the dedicated funding for research is delivered through the Canadian Institutes of Health Research, and they're the ones who deliver the research mandate. To reiterate what I said, we work very, very closely with them to make sure that type of research is being done so they can support our policies and our programs as we develop those as well.

[Niki Ashton, NDP, Churchill, MB]

There does seem to be, though, a disconnect, because we've clearly heard from CIHR that they've invested a fair amount of money and have come up with some pretty concrete ideas, and yet in your presentations we heard a lot about mental health, we heard a lot about the Canada Food Guide, but we didn't hear a lot about specific actions relating to eating disorders. So there seems to be a gap here between what's coming out of CIHR and what Health Canada is doing.