Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue 38 - Evidence - June 18, 2015
OTTAWA, Thursday, June 18, 2015
The Standing Senate Committee on Social Affairs, Science and Technology met this day at 10:28 a.m. in order to continue its study on the increasing incidence of obesity in Canada: causes, consequences and the way forward.
Senator Kelvin Kenneth Ogilvie (Chair) in the chair.
[Translation]
The Chair: Welcome to the Standing Senate Committee on Social Affairs, Science and Technology.
[English]
I am Kelvin Ogilvie from Nova Scotia, chair of the committee. I invite my colleagues to introduce themselves.
Senator Seidman: Judith Seidman from Montreal, Quebec. Good morning.
Senator Raine: Nancy Greene Raine from B.C.
[Translation]
Senator Chaput: Good morning. My name is Maria Chaput, and I am a senator from Manitoba.
[English]
Senator Merchant: Good morning. Pana Merchant from Saskatchewan.
Senator Eggleton: Art Eggleton from Toronto, deputy chair of the committee.
The Chair: I want to remind everyone that we are here to continue our study to examine and report on the increasing incidence of obesity in Canada: causes, consequences and the way forward.
Before we start, I want to advise the committee on two things: We have to give drafting instructions to the analysts, so this portion of the hearing will end at noon. Secondly, because of that and the number of witnesses, I will use one question per senator per round. We'll do multiple rounds until we are exhausted.
I will invite, from the Public Health Agency of Canada, Rodney Ghali, Director General, Centre for Chronic Disease Prevention.
Rodney Ghali, Director General, Centre for Chronic Disease Prevention, Public Health Agency of Canada: Thank you for inviting me to speak today about healthy weights and healthy active living, an important and ongoing priority for the Public Health Agency of Canada.
Since October, my colleagues and I have followed your work with great interest. As you have heard from many experts who have already appeared before you, obesity remains a complex challenge in Canada and around the world.
Overweight and obesity rates have never been as high as they currently are in Canada. Today, almost one in three children and youth are overweight or obese. And in adults, that's nearly half. Rates among children and youth have nearly doubled over the last 30 years.
As you know, obesity increases the risk of developing chronic diseases such as Type 2 diabetes, cardiovascular disease and cancer. The Public Health Agency of Canada's recently released report on cancer incidence projections highlights that obesity-related cancers are forecast to increase up to 20 per cent in the next 15 years.
Not surprisingly, we are starting to see children who are obese face the same health challenges as adults, such as Type 2 diabetes and high blood pressure. As you probably already heard, the direct and indirect health care costs of overweight and obesity are estimated at up to $7.1 billion per year.
Canadians generally know that eating well and being active are important practices to live healthy lives. However, as you have already heard from a number of witnesses, many factors, such as the environment we live in and the technologies that surround us, influence our ability to make healthy choices and can lead to unhealthy behaviours.
Addressing the causes of obesity requires a society-wide shift to change the social and physical environments that influence children's and families' eating habits and activity levels. And to accomplish this, everyone has a role to play in supporting healthy weights — governments, the private sector, the non-for-profit sectors, parents, communities and individual Canadians.
Federal, provincial and territorial governments have taken important steps to address obesity in Canada by setting up the building blocks necessary so that we can collectively achieve our goals.
In September 2010, federal, provincial and territorial ministers of health endorsed the Declaration on Prevention and Promotion, presenting their vision for working together and with others to make the promotion of health and the prevention of disease, disability and injury a priority.
Also in 2010, health ministers endorsed Curbing Childhood Obesity: A Federal, Provincial and Territorial Framework for Action to Promote Healthy Weights. They agreed to make childhood obesity a collective priority, to champion this issue and to coordinate work with many areas of Canadian society. The framework reflects a shared approach to turn the tide on this important challenge.
In November 2011, Ministers of Health endorsed recommendations and key areas of action that can be taken by governments to support healthy weights and reduce childhood obesity.
In 2013, health ministers released Towards a Healthier Canada, the first progress report to Canadians on the framework. The report highlighted collective actions taken to advance the framework as well as the most recent national data on factors associated with childhood obesity and healthy weights. Federal, provincial and territorial governments are now drafting a second report expected to be endorsed by both ministers of health and ministers responsible for sport, physical activity and recreation later this year or early next year.
Taken together, these initiatives represent an important stride forward. Governments recognize that curbing childhood obesity and overweight are a shared effort, and we have laid the groundwork for governments to work together and with other sectors. Collective activities and complementary actions between all sectors will truly help Canadians live longer, healthier lives.
Despite concerted efforts, traditional funding and awareness-raising approaches have not been effective in reversing these trends in Canada or abroad. At the Public Health Agency of Canada, healthy living and chronic disease prevention are key priorities, and we continue to work collaboratively to find the most effective ways to make healthier choices the easier choices for Canadians.
To advance healthy living and chronic disease prevention efforts, we need to be more rapidly identifying public health risks, trends, and emerging issues that affect Canadians.
We are doing this in part through our surveillance function. We are digging deeper into our analyses in the areas of mental health, sleep, physical activity and sedentary behaviour. We remain committed to understanding the burden of disease outcomes along with a focus on better understanding behaviours that can be promoted to advance health.
We are also exploring innovative interventions. We recognize that traditional awareness-raising approaches in healthy living and chronic disease prevention have not led to the desired results, so we are seeking new solutions to these complex problems.
Finally, we are committed to using our evidence and knowledge that we have garnered through our work to target change. Solutions that are found to be effective are shared and scaled up, and the lessons we are learning from less successful attempts are informing our future work.
I would like to take the next new moments to highlight some of the efforts we are taking to modernize our public health approaches in this area. Over the past several years, we have been transforming our policy and program levers to institutionalize a true whole-of-society approach. We are engaging non-traditional partners in our public health endeavours, leveraging their ingenuity, assets and expertise in previously unheard of ways, collectively working towards the common goal of producing better health outcomes for Canadians.
We have established a new multi-sectoral approach to our grants and contributions program. This approach enables us to work with the provinces, territories, the not-for-profit and the private sectors in a more profound and dynamic way to help children, youth and families live healthier living.
This new approach focuses on common risk factors — unhealthy eating, physical activity, and tobacco use — that underlie the major chronic diseases. It also incorporates a mandatory partnership component with the not-for-profit and the private sectors, the latter of which is required to provide matched funding towards our projects. To date we have leveraged over $27 million in private sector capital through this new approach.
One such example that has garnered international attention is our Air Miles YMCA initiative. This project incorporates new and unique tools such as the provision of incentives to encourage positive behaviour change. Through this partnership, over 75,000 YMCA members across Canada are receiving an incentive in the form of Air Miles reward miles for reaching physical activity milestones. This project is having a real impact. Two years into this project, the first of its kind in the world, and results are already demonstrating that participants are twice as active as they were before the program was implemented.
Another example is The Play Exchange, which was an initiative designed for government and its partners to speak directly with Canadians in a very different way. The Play Exchange was launched in 2014 by Minister Ambrose along with Canadian Tire, LIFT Philanthropy Partners and the Canadian Broadcasting Corporation. Through this partnership, Canadians were asked to submit their best ideas on how to get Canada more active. A group of high-profile judges selected the top six entries from over 400 applications received, and in January of this past year the top six ideas were showcased on a national CBC television special watched by over 3,000 viewers. And Canadians chose the winning idea by voting online.
The winning entry was the Canadian Cancer Society's Trottibus Walking School Bus, which received up to $1 million in funding to put their idea in action.
The Play Exchange was more than just supporting the winning idea. It was an opportunity to engage hundreds of thousands of Canadians in a dynamic dialogue over a 12-month period on how to get our country more active.
Healthy eating and regular physical activity are keys to good health. We are bringing many new partners to the table to identify and implement solutions. We are using our funding to leverage more investment, reach and innovation. The reality is that it will take time to see significant change. Complex societal challenges require multi-faceted solutions. One size does not fit all. But the momentum to address this public health imperative in Canada and globally exists.
In closing, I would like to thank the Standing Senate Committee on Social Affairs, Science and Technology for examining this important issue and for allowing us to share the new ways in which we are using our policy and programs for better impact. We look forward to reviewing the results of your report. Thank you.
The Chair: We will hear next from Health Canada, and we have Dr. Hasan Hutchinson, Director General, Office of Nutrition Policy and Promotion. Accompanying him is Dr. William Yan, Director, Food Directorate.
Dr. Hasan Hutchinson, Director General, Office of Nutrition Policy and Promotion, Health Canada: Thank you very much. I am pleased to be here to represent Health Canada, along with Dr. Yan.
Our branch supports and promotes the nutritional health and well-being of Canadians through a number of tasks, and these include firstly establishing policies, regulations, standards and guidelines related to the safety and nutritional quality of food sold in Canada, for example, by establishing nutrition labelling requirements. A second task is providing and promoting information on nutritious and healthy eating, including Canada's Food Guide. The third task is delivering evidence-based education and awareness initiatives and leading or contributing to broader initiatives to improve the food environment, making those healthy choices easier. Fourth is conducting scientific research and post-market surveillance in support of Health Canada's mandate to help Canadians maintain and improve their health. Fifth is providing advice and information to other governmental organization, industry, health organizations and consumers to support informed decisions.
Furthermore, the branch leads the health portfolio's nutrition-related responses under the Curbing Child Obesity framework that Mr. Ghali just presented.
Health Canada's goal is for Canadians to be among the countries with the healthiest people in the world. We know that healthy eating contributes to health at every stage of development and is critical in reducing the risk of nutrition-related chronic diseases and obesity. Food choices are influenced by both individual and collective factors, including social and physical environments. Health Canada therefore employs a spectrum of interventions that target individuals, intermediaries and the broader policy environment.
One well-known Health Canada nutrition initiative is Canada's Food Guide, which translates the science of nutrition and health into a healthy eating pattern for Canadians. It remains the most popular Government of Canada document and forms the basis for policies and programs across the country.
We recognize the need to remain relevant and are modernizing the way we communicate this dietary guidance. For example, we just launched the Eat Well Plate, a consumer-friendly visual that simplifies a healthy pattern of eating, and we also just launched a mobile application that allows consumers to customize the food guide for their own circumstances.
As noted earlier, Health Canada is also responsible for setting policies for health and safety-related labelling. Canada was one of the first countries to have mandatory requirements for nutrition labelling on food products. This includes the nutrition facts table, which companies are required to display on most pre-packaged foods sold in Canada. This mandatory requirement came into effect in 2007 and requires a nutrition facts table that lists the 13 core nutrients, including fat, sugars and sodium. The purpose of the NFT is to convey information in a clear and uniform manner about the nutrient content of food and to enable consumers to choose and compare products and make informed healthy food choices.
Health Canada also has set regulatory criteria for phrases such as "lower in sugar" and "sugar-free" to ensure that they are consistent, accurate and not misleading to consumers.
You have also likely heard about our recent announcement on proposed improvements to the nutrition labelling regulations, which will make the labels more consumer-friendly. Among the proposed changes, calories are displayed more prominently, a daily value is proposed for sugars, and serving sizes would be regulated to ensure they are more consistent between similar products and better reflect the amount of food Canadians typically consume at one sitting.
We have also proposed changes that would make the list of ingredients easier to read and to makes it easier for consumers to identify the sources of sugars added to foods. These changes aim to provide Canadians with more of the nutrition information they need to make informed decisions about the foods they buy and prepare for themselves and their families.
However, we recognize that food choices are influenced by many factors and that while we have an important role in providing the best information to consumers about healthy eating and the nutritional content of foods, we need to do more. A policy priority in the Curbing Childhood Obesity framework is to improve food environments and, in particular, to increase access to and availability of nutritious foods. Health Canada is supporting improvement to food environments by working with provinces, the territories, public health authorities, health organizations and food industry stakeholders to increase understanding of how best to provide and promote healthier options to consumers while respecting the food industry's need to be competitive. Ultimately, these efforts will lead to policy changes that support healthy eating by making it easier to choose nutritious foods.
Health Canada's guidance, education, policies and regulations are grounded in the best available scientific evidence. We collaborate with others, such as the U.S. government, to develop dietary reference intakes. We partner with Statistics Canada to gather consumption data to better understand what Canadians are eating, and we work with the World Cancer Research Fund and the World Health Organization to assess policy interventions.
Combined with our evidence review cycle for dietary guidance, Health Canada is at the forefront of knowledge development and exchange about nutrition and its impact on chronic disease and obesity. I would like to conclude by echoing the sentiments of so many witnesses. No one organization will solve this issue alone. Health Canada will continue to work with our internal and external partners and stakeholders to help make healthy eating easier for Canadians, not only to reverse the obesity trend but also to improve the overall health and well-being of our society.
Thank you very much for this opportunity. We are looking forward to your questions.
The Chair: I will now turn to Dr. Jane Aubin, who is Executive Vice-President, Chief Scientific Officer at Canadian Institutes of Health Research, commonly known CIHR.
Dr. Jane Aubin, Executive Vice-President, Chief Scientific Officer, Canadian Institutes of Health Research: Thank you, Mr. Chair and honourable committee members. I would like to thank the committee for inviting me and my colleagues from the Health Portfolio here today. I am pleased to be able to highlight some of the excellent research that the Government of Canada is supporting in the area of obesity.
As this committee knows well, the Canadian Institutes of Health Research, or CIHR, is the Government of Canada's agency responsible for supporting health research excellence in our universities, hospitals and research centres across Canada.
CIHR consists of 13 research institutes, and as chief scientific officer, I oversee the science strategy of our organization. Several of our institutes support research related to obesity. However, there is one lead institute, the Institute of Nutrition, Metabolism and Diabetes, that is specifically mandated to support research on diet and metabolism to address the causes, prevention, screening, diagnosis, treatment and support systems for obesity.
CIHR issue invests heavily in obesity research. Between 2006-07 and 2013-14, CIHR invested $259 million towards this area. Investments over this same period have increased by almost 30 per cent, helping to position Canadian researchers at the forefront of this field internationally. Globally, Canada ranks among the top five countries for total number of scientific publications on obesity. The tremendous work of Canada's researchers is helping us to assess and identify the most effective interventions and prevention strategies to address obesity in Canada and elsewhere.
For example, CIHR is supporting the work of Dr. Scott Leatherdale from the University of Waterloo. Dr. Leatherdale's research is providing valuable new insight for planning, tailoring and targeting school-based initiatives where they are most likely to have impact. In one of his projects, Dr. Leatherdale examined school built environment and its association with being overweight. He found that the more fast food and grocery stores there were around a school, the more likely a student was to be overweight. He is also currently leading the Compass study, which evaluates how changes in school policies, programs or the built environment are related to changes in youth health behaviours, including those related to obesity.
CIHR is honoured to support the work of Dr. David Hammond, also from the University of Waterloo and an investigator on the Compass study. Dr. Hammond's research evaluates existing health policies and regulations and explores the impacts of novel interventions. Dr. Hammond has determined that displaying calorie amounts on menus can help reduce excess energy intake in university students. In another study, he discovered that children were three times more likely to order a healthier meal option when toys were not offered in unhealthy meals. This study's findings suggest that policies to restrict toys with unhealthy meals may promote healthier eating at fast food restaurants.
As you can see, CIHR supports a wide variety of top-of-the class researchers in this field with and is very proud of the work they do. In fact, 20 of the witnesses you have had before you have received funding from CIHR since its inception in 2000.
Mr. Chair, the committee has already learned that Canada's First Nations, Inuit and Metis populations are particularly affected by obesity. This is in part why CIHR has developed a priority initiative called Pathways to Health Equity for Aboriginal Peoples. This initiative aims to develop the evidence base in how to design, offer and implement programs and policies that promote health and health equity in four priority areas, one of which is in diabetes and obesity. Just a few months ago, in March 2015, the inaugural Pathways Annual Gathering was held in Ottawa. The event brought together 140 researchers, community partners, Aboriginal organizations and members of the Health Portfolio to discuss the Pathways initiative, exchange knowledge, develop partnerships, and lay the groundwork for having impacts.
At this gathering, CIHR's Institute of Nutrition, Metabolism and Diabetes hosted a session specifically to enable cross-learning, knowledge exchange and mentorship among those engaged across the Pathways initiative and its funding opportunities.
Under the Pathways initiative, CIHR supports the work of strong researchers who are looking for ways to combat obesity in Aboriginal populations.
For example, Jon McGavock from the University of Manitoba is investigating the effectiveness of innovative school-based methods for preventing obesity and Type 2 diabetes in First Nations children. This idea was sparked from the fact that diet and exercise alone have no long-term impact on body mass index or reducing waist circumference in children. Instead, his interventions are focused on fostering resilience. In particular, he will be looking at how children raised in low socio-economic environments are more likely to become overweight or obese, particularly First Nations youth. This research is designed to develop after-school programs that protect youth living in poverty from excessive weight gain.
Mr. Chair, I would also like to highlight an important event that CIHR is proud to sponsor each year, along with private sector partners such as the Heart and Stroke Foundation. The Canadian Obesity Summit is a unique interdisciplinary conference that is as much a networking event as it is a cutting-edge research conference, as it advances knowledge sharing and current understanding of the causes, complications, treatments and prevention approaches for obesity. This year's summit took place in Toronto from April 28 to May 2. Attendees of this event included health professionals, researchers, policy-makers, industries, media and members of the health portfolio.
At this year's summit, the Minister of Health announced $4.5 million over five years to support three new research teams focused on improving bariatric care for Canadians, and that involves research for prevention, treatment and management of obesity, including lifestyle interventions and modifications, cognitive and behavioural therapies, pharmacotherapy and surgery. The funding is being provided by CIHR and by public and private sector partners, such as the Canadian Obesity Network, the Ontario Ministry of Health and Long-Term Care and the Fonds de recherche du Québec — Santé. The goal is to support research that will help people who are obese lose weight and improve their overall health and quality of life.
Also at the summit, CIHR hosted a symposium to profile these three new bariatric care teams. One of these teams is led by Dr. Geoff Ball from the University of Alberta, who will study the prevalence of severe obesity in children, examine the health risks that come with the problem, and study the factors that lead a doctor to suggest bariatric.
In conclusion, Mr. Chair, CIHR remains committed to continue working with our public and private partners to support world-class Canadian researchers in the field of obesity to ensure the translation of research results into improved services and treatments. Additionally, we are looking forward to continuing to build the evidence base by funding future research under new CIHR initiatives — and one that I haven't mentioned — such as the Environments and Health Signature Initiative, which focuses on research to modify the environments in which people live, work and learn.
Again, I wish to thank you for providing me with the opportunity to speak on this important issue. I will be pleased to answer any of your questions.
The Chair: Thank you very much.
Now we will turn to Statistics Canada. We have Josée Bégin, Director, Health Statistics Division; and Julie Bernier, Director, Health Analysis Division. I understand you're sharing your time and that Ms. Bégin will begin.
Josée Bégin, Director, Health Statistics Division, Statistics Canada: Thank you, Mr. Chair and honourable senators. We would like to thank you for your invitation and for allowing us to present today some information on obesity collected by Statistics Canada.
Our presentation will briefly cover current sources of information on obesity. I will also inform you of future sources of data on obesity over the next few years, and Julie Bernier will present some analytical findings on obesity, physical activity and nutrition.
There are currently three sources of information at Statistics Canada that collect information in relation to obesity. The first one is the Canadian Community Health Survey, which covers the population 12 years old and older. The information collected is self-declared. For example, we ask questions such as these: How much do you weigh? How tall are you? Do you consider yourself to be obese, overweight or just about right?
This CCHS also collects information on physical activity for leisure, such as the type of activity and the time spent on the activity, as well as information on walking and/or biking to work or school.
The Canadian Health Measures Survey covers the population aged 3 to 79 years old. Contrary to the Canadian Community Health Survey, the Canadian Health Measures Survey collects the information directly from the respondents by combining an interview in the home of the respondents with a visit to our mobile clinic. The information collected in relation to obesity is the following: height, while the respondent is sitting and standing; weight; waist, hip and neck circumferences; skin folds; and physical activity. For physical activity, the respondents use a wearable device recording their activities during seven days.
The Nutrition Survey collects information from Canadians over the age of 1 year old about their eating habits and use of vitamin and mineral supplements, as well as other health factors. We collect information by measuring weight and height, and we also collect information on physical activities over the last seven days, whether it is during class or outside of class, or for leisure, when a total of at least 60 minutes per day is reached.
I have provided more details on those surveys in Annex 1 of the presentation.
Now I would like us to take a look at upcoming sources of information on obesity at Statistics Canada.
First, the Canadian Health Measures Survey will continue to collect information directly measured from respondents in relation to weight, height and physical activity over the next few years.
Second, the collection for the Nutrition Survey is currently in progress and will end in December 2015, with results being released in the fall of 2016.
In addition to the information collected in a self-declared manner on height, weight and physical activity, the Canadian Community Health Survey will collect some information on healthy behaviours, focusing on the food guide use, in 2016 and 2020.
In addition to those surveys, we are currently working towards the development of a pilot survey on the health of children and youth for the fall of 2016. While we have not finished developing the questions for the pilot survey yet, the survey will include questions on height and weight, fruit and vegetable consumption, beverages and meals, food behaviours, eating disorders, and physical activity.
More information on the pilot survey on the health of children and youth can be found in Annex 2 of the presentation.
Julie Bernier, Director, Health Analysis Division, Statistics Canada: I will now present results from work on obesity, physical activity and nutrition.
In some of our older publications, we were using body mass index cut-offs developed by the International Obesity Task Force to define obesity for children. Using directly measured height and weight, we estimated that in 1978, from a survey collected by Health Canada, 2 per cent of Canadians aged 2 to 17 were obese, and that number moved up to 8 per cent in 2004.
More recent publications are now based on the WHO cut-off points to classify children and adolescents according to their body mass index. I am mentioning that to you because on a variety of publications you can see different numbers for 2004, depending on the metric that is applied.
Using this new norm, but still doing direct measures, we estimated that between 2004 and 2013, the percentage of obese children and adolescents has been stable at around 12 per cent. During the same period, the estimated percentage of children and adolescents who are overweight has also remained stable, around 20 per cent.
Physical activity and nutrition are two potential determinants of obesity. Using directly measured physical activity, it was noticed that children are more active during lunchtime and on weekdays, and teenagers tend to be more active after school and during weekdays.
Guidelines supported by the Public Health Agency state recommendations for moderate and vigorous activity, as well as recommendations for vigorous activity alone. Seven per cent of children and teenagers meet the recommendation for the combination of moderate and vigorous activity, which is at 60 minutes a day. Forty-four per cent meet the recommendation for vigorous activity, which means it is observed three or more times a week for a certain length of time that is very short. All Canadians together, adults and kids, are sedentary more than 60 per cent of the time they spend awake.
Last, using the 2004 CCHS Nutrition Survey, the last collected cycle on nutrition — the new one is coming, as Josée mentioned — some findings on nutrition that have been published are around sugar consumption, which has attracted a lot of attention.
The average Canadian consumes 26 teaspoons of sugar a day. For children and adolescents, 44 per cent of their sugar intake comes from what they drink, that is, beverages. Some come from milk, fruit and juice, but calories from these two items tend to decrease as kids age and move on to other beverage categories. For adults, 35 per cent of sugar intake comes from beverages.
Other findings about physical activity and nutrition have been determined by the research division at Statistics Canada. I distributed a list of publications that have been done over the last four or five years, including the results. We also have a certain number of publications around methods and techniques to do measurements and validate data.
Thank you for providing an opportunity for us to present today.
The Chair: I will remind my colleagues that we will use the one question per senator per round method. I will ask you to direct your question to a specific witness to begin.
To the witnesses, if the senator then says do any of you have anything else to say — and you have lots to say; you can all speak at great length on all of these issues — if you do have something new to add, then signal through the chair that you want to respond. However, if you do not have anything new to add, please do not repeat. We will be tight for time and I want to get as many questions in as I can.
With that, I will start the questioning beginning with Senator Eggleton.
Senator Eggleton: For my question on this round, I will ask you, Dr. Hutchinson, to talk about Canada's Food Guide, which, as you point out, is the most popular government document around. In the time that it has been around, obesity has taken off in epidemic proportion, so it hasn't had much effect on that.
We have had some critics here during our meetings. They talked about the food guide not being regularly updated, saying that it remains largely the same as it was when it was first developed, that it is not evidence-based, that it attempts to meet nutrient requirements rather than promoting broader food-based patterns of eating, and that it does not effectively emphasize the foods that should be avoided.
You say today that you just launched the Eat Well Plate. I would be interested in knowing how that fits in with all of this.
My main question is really this: When does Health Canada intend to update the food guidelines and will the update include a large-scale public consultation?
Dr. Hutchinson: I appreciate your questions, Senator Eggleton. Yes, you are right, it is the most popular — well, at one time the tax forms were more "popular," but I think we are still more popular.
The main thing you were talking about concerns whether we are looking at the evidence and will we do some updating of the food guide. I will concentrate on that because we could talk the whole afternoon on all of your other preambles.
We have initiated an evidence review cycle where we are looking at a variety of different forms of evidence that goes into forming dietary guidance. We have been looking at three different pots of evidence. The first pot has to do with the straight scientific evidence that goes into the dietary guide. We are thinking here about the dietary reference intakes or straight nutrient updates that we are aware of and the effects of different types of foods on health as well — that is, a broader look at what you are eating and your health. It is that component of the straight scientific evidence that goes into the pattern.
The other evidence we have been looking at — and we instituted this about two years ago — is how Canadians use the food guide and how stakeholders use the food guide. For that one, working with Stats Canada, we did a 10,000-strong representative sample using the Canadian Community Health Survey. We went out to consumers to get evidence about how they use it and how they have incorporated it into their life. We also did a substantive study looking at the different types of stakeholders that use our policies and incorporate them, whether it is the provinces, the territories, the dietitians or other professionals, so that we have the use aspects of it.
The third component of the evidence that we have been looking at concerns the Canadian context behind our dietary guidance. Part of that takes into consideration how Canadians have been eating, what the consumptions are and how the food supply has changed.
For two years, we have been doing a focused look at the evidence in those three pots. In February, we released the study about how Canadians are using it and how stakeholders are using it as well. It is used by Canadians and also by the different types of stakeholders that we have in the country. It is incorporated completely into the policies of the provinces and territories, for instance.
With respect to the evidence review on the scientific side from the DRI, the dietary reference intake side, whereas we work with the Americans and the Institute of Medicine on that, our main work in the last few years has been to do with vitamin D and calcium. That information has been updated, and we have updated our guidance with respect to those particular nutrients.
On the scientific side, that has to do with the relationship between different types of food and health. We are concluding that right now and are bringing all of that together. In the next few months, we will be sharing that information coming forward.
As we bring all of the evidence together, you then have to make a decision on what we have to do with respect to our dietary guidance and what sort of actions have to come out of that. You can think of three different types of action. First, people are misunderstanding things, so we have to change our awareness and education activities to deal with that. There may be some errors of interpretation, so we have to modify our guidance. Or we could make the decision that the evidence base has changed so much that we have to re-launch the creation of brand new dietary guidance and a new food guide or dietary guidance for Canadians. That is the process we are in right now. Again, we will base that on the evidence that we have. We will not a priori say we will do this unless we have the evidence to show that it is the right approach.
A related question you had concerned how we are starting to present it for the consumer. We launched the Eat Well Plate about 10 days ago. This was in response to what we heard from consumers and stakeholders about the use of Canada's Food Guide. They sometimes had trouble understanding serving size and the number of servings, so we have gone to a lower numeracy and literacy approach where it is a plate approach. The main message we will be running with on that is to make half of your plate vegetables and fruits. We just released that. We will go much further with that as well. Again, it is having multiple forms available to get dietary guidance. This is one that I think dietitians and other health professionals can use in their interactions with the consumer, and it is easier to understand intuitively.
For those who want more detailed information with respect to the number of servings and understanding the serving size, we have launched a mobile app for the food guide. You can have the food guide with you on your tablet or cellphone at all times. You can have it represent who you are with respect to your sex and age category. You have requirements there, but you can also choose the type of foods you are eating so that you can get guidance with respect to the servings and how much amount of food you should have as well. That is one area that came up most strongly when we were talking about the food guide. That is, people were having trouble understanding what amount a serving was in the food guide.
Senator Seidman: Thank you very much for your presentations.
One issue we have often discussed and we have heard about from witnesses has been the suggestions that food advertising to children should be prohibited. CIHR, PHAC and Health Canada all do evidence-based research.
I am not sure who to address my question to, but I would appreciate a response from any or all of you. Have you looked at the effectiveness of Quebec's prohibition on advertising to children? If so, what have you concluded?
Dr. Hutchinson: No one else wants to jump in? Okay, it will be me, I guess.
What we have done with respect to looking at marketing to children — and I am talking here about the greater "we," as part of the Curbing Childhood Obesity process, working with provinces and territories as well — when we wrote the actions that Rodney talked about, back in 2010, as a collection of jurisdictions, we decided that we would concentrate on really being supportive of the industry-led childhood advertising initiative and help them to make that service a stronger initiative. That has been where we, as governments, have been committed.
The provinces and territories, on their side, have controlled the amount of advertising and the particular setting. Again, as part of the Curbing Childhood Obesity initiative, in schools and recreation centres, different settings where children find themselves, that is more of a provincial or territorial responsibility. They have certainly moved on that side of things.
We are, as well, looking at the different sorts of interventions that have happened around the world and in Quebec, as you noted. We are looking at the evidence that comes in from the other countries and reviewing that and trying to figure out what the right approach would be as we go forward. Certainly, at the level of our Curbing Childhood Obesity initiative, with our provincial and territorial partners, we are starting to do an assessment of what has happened in the first five years. We are really trying to figure out, as a collection of jurisdictions, what sort of approaches we should be taking with respect to marketing to kids.
The Chair: Two of our senators need to leave to go to National Finance, which is dealing with an important budget bill. I had recognized Senator Chaput as next, and Senator Merchant is going to ask her question and maintain her position on the roster.
Senator Merchant: Thank you so much, chair; I appreciate that. Senator Chaput just left. She left me with this question for Statistics Canada. She said that you were doing another survey, a pilot project that you spoke of. She wanted to know who and what this is focusing on. She would like to know whether there will be questions directed to publicity toward children. Those were her questions. Perhaps you could answer those.
Ms. Bégin: The pilot that I mentioned in my presentation will be focusing on children and youth, looking at children from 1 to 17 years old. At this point, not all of the content has been decided yet. We are working with our stakeholders, including the Public Health Agency of Canada and Health Canada, to finalize the content. We have also undertaken some focus group testing with respondents to see how the concept and the questions have been understood.
We are planning to do the pilot in the fall of 2016. At this time the questions in terms of advertising have been raised through our working group meetings. I believe that it had been decided that we would see the reaction of our respondents in focus group testing to see whether or not they can answer it or whether we can maybe target a more specific amount of time, but it has been discussed. However, no final decision has been made as to whether or not that type of question would be on the pilot survey.
Senator Raine: I appreciate you all being here today.
Recently, the U.S. government prohibited trans fats. I'm just wondering if our government will be following.
Dr. William Yan, Director, Food Directorate, Public Health Agency of Canada: Thank you very much for the question, senator. Yes, that was announced two days ago. The U.S. has confirmed that they will now be declaring partially hydrogenated oil, which is contributing to trans fat, to be no longer recognized as generally safe. If companies want to use this product, they will have to apply to the FDA and get approval to use it in any food products.
In Canada, we have worked on trans fat for many years already. There was a trans fat task force that published a report back in 2007 with recommendations on the level of trans fat that should be present in the food supply, both in oils and in food products themselves.
Since then, Health Canada has taken on a multi-faceted approach to address the problem of trans fat in the food supply. We have used regulation to mandate that all packaged food products have to declare trans fat on the nutrition facts table so that consumers will know whether a product contains trans fat and how much trans fat is there.
Second, we have monitored the food supply since 2007 to see if industry has actually reduced trans fat levels in the products.
In 2009, at the end of our monitoring, it showed that the prepackaged food products have decreased trans fat up to 75 per cent. Since then, there have been more recent studies done at the University of Toronto that show that, in the following two years, from 2009 to 2011, we have 97 per cent of the products tested now meeting the trans fat target set by the task force. Industry has, in fact, reformulated their products, and they have now taken trans fat out of most of the products. There remain a few categories of products, though, that still maintain trans fats, and we are working with industry to find a solution to reduce trans fat in those categories of food as well.
Also, consumption data shows that Canadian consumption of trans fat, in some populations, is now meeting the targets set by the World Health Organization. This is a good example of how we have used a mixture of regulations, as well as monitoring and research, to encourage industry to change the product profile so that, in Canada, now the consumption of trans fat is at a level that is much lower than it was before we engaged in these activities.
We will be monitoring what the U.S. is doing. In fact, they are not officially banning trans fat; they are just declaring trans fat to be no longer regarded as safe. They will be looking at submissions and deciding whether trans fat can still be used in some products, but companies will have to demonstrate that the use is not going to be causing any adverse health effects.
Senator Enverga: Thank you for the presentations. There is too much knowledge here right now. It is hard to ask only one question. My question, though, is on the labelling part.
Dr. Hutchinson, you mentioned that you will be making labelling very clear and that each label will give you all of these fascinating facts about each kind of food.
What is the plan of implementation for this? Let's say, for every kind of pop, are you going to mention the amount of whole sugar? I heard this on TV. Are you going to label the whole sugar level? Is that how you are planning to do it? What is going to happen?
Dr. Hutchinson: I will leave this for Dr. Yan as well.
Mr. Yan: Last Friday, actually, Minister Ambrose announced that we are now proposing some very expansive changes to the current labelling regulation. This is now in the process of the Gazette I consultations, starting last Friday. Canadians will have until August 26 to comment on all of the proposed changes that we have made. Some of the key changes we have made address a lot of concerns we have heard from consumers over the last year, both directly in meetings and in online surveys. Some of the biggest complaints we heard were that they did not like that they cannot compare two similar foods because the serving size is different. Second, they also complained that a lot of information cannot be read because it is not legible. Third, they also wanted more information on sugar. Among all of the changes we proposed, we actually targeted those three key areas to improve the label. For example, we are making parts of the label more prominent — calories, as well as the serving size. We are increasing the font size and contrast in the ingredient list, so you don't have to take your glasses off to look before you can find out what is actually in the product. We have been updating all of the DV, daily values, to make sure they are scientifically sound. Most importantly, we are now introducing, for the first time, a mandatory declaration of the daily value for total sugar. Therefore, when a customer looks at a product, they can see that this product contains a certain percentage of the daily value and they can then use that in combination with the rule for educating consumers, which is if you see a DV of 5 per cent it means there is a little of that nutrient; if it's 15 per cent or higher there is a lot. So if you see a total sugar DV of 25 per cent, they would know right away that this food contains a lot of sugar and they should be treating it with some caution and not consume too much of that product. If it's 5 per cent or less then there's not a lot of sugar and they can probably consume a bit more. That's a quick way for the consumer to determine the level of sugar in a product.
Also, we will be the first country to now mandate industry to group all the sugars on the ingredients list together under the heading "sugar." If you look at the label now, different forms of sugar can be spread out throughout the label depending on the quantity, and the consumer can lose track of how many actual different sugars are there. By grouping it altogether under the word "sugar" it will put them together and it may actually push it up the list because now the amount of total sugar may be higher than what was presented previously.
Again, the consumer will quickly know from the ingredients list how many sugars are added and, proportionally, how much sugar is in the product.
All of these changes, as I said, require changes to the regulation, so it has to go through the Gazette process. After the comment period, Health Canada will be analyzing the comments from the Canada Gazette I consultation. We may have to make further revisions to the proposal and then it will be published in the Canada Gazette, Part II, as final regulations.
It has been proposed that we will give industry up to five years to make the final changes. That's because industry needs to change the labels and some of the small industries actually preprint labels and they have to use them up before they can use new labels. That does not mean that new labels would not come out for five years; they will come out very soon after the regulations are promulgated. But industry will have up to five years for the last label to be changed.
That is exactly what happened back in 2002 when we first introduced the original labelling regulations. We gave industry up to five years for everyone to have the right label, but we saw changes much earlier than that.
Senator Enverga: Are you planning to have this labelling adopted for children?
Mr. Yan: The label is for all Canadians, yes.
The Chair: It is a standard label.
Mr. Yan: It is a standard label.
The Chair: Thank you very much.
Senator Merchant: I will direct my question to Mr. Ghali. You have created a best practices portal. I would like to have more information about it. With regard to what Dr. Aubin said about the special challenges faced by our First Nations, our Aboriginal communities, you have a section in that portal that's dedicated, called Aboriginal Ways Tried and True.
Mr. Ghali: Yes, that's right.
Senator Merchant: I would like to know how you communicate this to your stakeholders and whether there has been any reaction to it.
Mr. Ghali: At the Public Health Agency of Canada we have an online platform called the Canadian Best Practices Portal. The idea behind that portal is a conglomeration of the best and most promising practices of a whole array of interventions both on a healthy living spectrum. Those are practices that governments, non-governmental organizations and others have put out in the field to get Canadians more active and also to prevent chronic diseases.
They go through a rigorous evaluation methodology to determine whether they meet a standard of an intervention that is deemed a best practice or a promising practice based on the scientific evidence that is out there. Through that array of programming that's out there, we have hundreds of best and promising practices on this portal. You are right; in particular, there is the Aboriginal Ways Tried and True section of the portal, which was recently released in consultation with Aboriginal organizations across Canada to adapt the way in which we look at the methodology to assess whether something is promising or a best practice given the evidence out there.
We have worked with our stakeholders in those communities to promote the knowledge of the best practices portal in general, but in particular there is this stream of knowledge.
As my colleagues have already stated, we are taking a multi-faceted approach to this. Through the agency we are working with First Nation communities off reserve with some of the interventions that we are promoting in the agency. We have colleagues at CIHR that are working with First Nation communities on and off reserve to better understand the conditions that will be more conducive to being more active, reducing tobacco consumption and eating better. As time goes on, it's our hope that the body of evidence that we see coming out of all of these collective efforts will eventually rest on the portal and be disseminated through our work and the work of others.
Senator Nancy Ruth: My questions have to do with Canada's Food Guide.
Senator Eggleton raised the issue of whether you put on what not to eat or drink on the guide and if you do or don't I'd like to know. If you were to do such a thing, what do you think the impact on corporations would be?
When you're doing your plate shop thing, do you ever put down, say, a week's meal planning? What would a healthy week of meals be and do it four times so people actually have something to follow rather than just a plate?
Dr. Hutchinson: With respect to those things that avoid, Canada's Food Guide has a lovely purple box that lists outside to avoid the following items. They are usually the foods high in fats, sugars or sodium. These tend to be, of course, the highly processed foods that we are wanting people not to eat, so that's pretty clear.
As a matter of fact, I think I noticed the Brazilian food guide on somebody's table there. If you actually look at the things in the Brazilian food guide, it's almost word for word what we're saying on our food guide with respect to things to limit as well. I think they call it "ultra-processed foods" or something like that.
On the food guide there is a clear box there that points out the things to avoid, and again, it is in concurrence with what the Americans say in their dietary guide and what the Brazilians and the Australians say in their guides. That is clearly right there, and that sort of message comes up a number of times in the food guide as well with respect to when you are preparing foods at home — you want to prepare them with lower amounts of fats, sugars and sodium — and whether or not you're purchasing foods or whether you're out in restaurants as well. That's not in the food guide, but in our educational materials as well.
Senator Nancy Ruth: Has there been any reaction from industries regarding sugary drinks or juices or whatever? I guess you don't name a product.
Dr. Hutchinson: Sugar-sweetened beverages are named in there; we talk about cakes, muffins and stuff like that. Certainly at the time of the broad consultation that happened back in 2006 — we released it in 2007 — there were 7,000 comments that came up in our broad public consultation. It was in that, I would assume, that several industry groups were making recommendations.
Ultimately what happens when you do that sort of broad consultation is that it still comes down to us making the best guidance available based on the best evidence, so you still have fairly strong statements with respect to those types of foods that we wants Canadians to limit or avoid.
Senator Nancy Ruth: Just so you know, I have been on my iPad and typed in "Canada Food Guide" and it doesn't come up easily at all. I still haven't found it.
The Chair: We will deal with that as a technological issue later.
Dr. Yan, I want to come back to Senator Eggleton's question. I don't think I totally understood your answer.
In the label on foods you have a number for total fat in grams, and it is a percentage of daily value. Below that you have listed saturated fat and trans fat. The total of those two comes to a much higher number than the daily value of total fat. In other words, total fat isn't including trans fat; is that correct?
Mr. Yan: Yes. I can clarify that. Currently, it's mandatory that the label has to declare the amount of both saturated fat and trans fat. Those are listed in grams.
The daily value is the combination of trans fat and saturated fat — all the fats together. We do not have a separate daily value, DV, for trans fat declared on the label.
In fact, last July we proposed the possibility that we would separately declare both trans fat and total fat as a DV. We received a lot of comments from consumers as well as health and industry stakeholders. The overall consensus was that separating out trans fat as a DV would not be helpful because trans fat can come from different sources. A lot of meat products, for example, have natural trans fat. The trans fat we're focusing on is what we call industrial trans fat, which is generated by oils being processed. By declaring a separate trans fat DV, it was felt that foods containing natural trans fat, which we can do little about, would negatively impact consumption of those healthy products when they don't contain industrial trans fat. That's why our final proposal was to stay with the status quo, which is listing the trans fat in its amount but not as a separate DV for trans fat.
The Chair: Your target, as you responded to Senator Eggleton, for the percentage of trans fat in foods is 2 per cent.
Mr. Yan: The task force recommendation for oil is that it cannot be more than 2 per cent trans fat. For all food products, no more than 5 per cent of the total fat concentration should come from trans fat. It's a little complicated because you can't tell that from the label, so you have to do some mathematics. You have to know how much fat is there to begin with and how much of it is trans fat.
The Chair: I understand that it's complicated. I also understand that natural materials have some trans fat. We're talking about added trans fat as an issue. There is no safe value of added trans fat. I don't understand: 97 per cent of what has reached your target level?
Mr. Yan: The study at U of T looked at all the labels of mostly processed foods, at how much trans fat there is, and how much total fat there is. The researchers did the calculation to make sure that the trans fat proportion is below 5 per cent. If the product meets that target, then they've met the target recommended by the task force in 2007.
You cannot go for 0 per cent, even for oil because any processed oil will generate a tiny amount of trans fat. You cannot stop that. Even healthy oil, when analyzed, contains a small amount of trans fat.
The Chair: The 5 per cent is not a trace amount.
Mr. Yan: The 5 per cent is in the overall product.
The Chair: I understand. You're talking about grams, not milligrams; so 5 per cent of the fat in products is a significant amount. It's not a microscopic amount.
Mr. Yan: That is correct. That was the final recommendation of the task force that did more than a year of analysis and was made up of health care professionals; and the Heart and Stroke Foundation also endorsed the recommendation.
The Chair: And industry, right?
Mr. Yan: As well as industry.
Senator Eggleton: I want to keep with labelling. One of the other things that shocked me about your answer to Senator Enverga's question was five years. That's beyond me. Health hazards have been created by eating unhealthy; and it's costing the government a lot of money. I would hope you can get that down to two years.
My question is on front-of-package labelling. As people go down the aisles in the grocery store, they don't see the nutrition facts label, which is on the side or the back. Hopefully, they'll be easier to understand after they get through the exercise you have described. It's very hopeful, except for the five years.
On front-of-package labelling, which a number of witnesses talked about, we were given some examples. In the U.K., they use the green/red stoplight system. The NuVal system that came out of Yale University is another one; and some suggested you can combine the two. For example, Loblaws has its blue label, which stands out right in front. What are you suggesting in terms of front-of-package labelling that would be easy to understand, certainly easier than the label even with the revisions probably.
Mr. Yan: We got a lot of comments in our consultation for labelling. We heard from consumers and health stakeholders that the front-of-pack labelling could be a useful tool to guide consumers to a better choice.
What we heard and what's been found in some recent surveys that we've done is that the majority of Canadians want to use the nutrition facts table as their reference. They have complained that certain aspects are not easy to use, and so we have taken steps to try to improve that. Canadians believe that the NFT is more reliable and accurate information. You're correct in saying that there are a number of different systems for labels. The Loblaws example you mentioned is a different type. It's the shelf-tag system, where it's not on the label. It's on the shelf next to the price tag. It's a combination of different symbols — the guiding star, symbol for Loblaws, which has the Blue Menu, is the shelf-tag system.
A lot of studies are being conducted to look at the actual effectiveness of these systems. The accuracy of how the star ratings are done is really important because the basis for that isn't always consistent. At times, consumers can actually be misled, depending on the foundation for those rating systems. Health Canada is looking at all those systems to see if there is any way to bring some consistency. The U.K. has the traffic light system. We know that last year Australia launched a health star system. In that situation, the government actually developed some of the criteria that will be the basis for the system, but they did not develop the system for the whole country. Anybody wanting to do a rating system will have to use those criteria to ensure that they are consistent.
Right now, Health Canada is looking at all the different factors and deciding whether there is something we need to do to use front-of-package labelling to complement what we're doing on the back of the label along with all the changes to the NFT.
Senator Seidman: I continue to pursue advertising. Last week we heard from the CRTC, Advertising Standards Canada and the Association of Canadian Advertisers. We discussed the Canadian Children's Food and Beverage Advertising Initiative: 2013 Compliance Report. I asked specifically how certain healthy food categories met requirements to be advertised to children. It was said that they meet the criteria, which are foods that reflect the dietary guidelines of Canada's Food Guide or foods that meet the criteria for disease risk reduction claims, function claims per CFIA's food labelling for industry, nutrient content per the CFIA's food labelling for industry, or food that meets standards for participating heart and stroke health check programs, et cetera. These criteria applied until the end of last year.
I found that kind of mystifying, and so I asked about the list of advertised products that are in compliance in 2013. Fruit roll-ups are there, for example, and we heard that something like fruit roll-ups are pure sugar. The answer that I received was that many of the products, such as fruit roll-ups and Pepperidge Farm Goldfish snack crackers and a whole list of things, contain either a source of calcium or a source of vitamin C or a source of something else, and therefore they meet the so-called criteria for nutrient content claims.
I guess I'm putting that to you because I find that pretty disturbing. I would like to know how we're looking at beefing up the nutrient criteria components so that we can deal with this kind of advertising issue.
Dr. Hutchinson: You're absolutely right. You're talking about the 2013 compliance. In those early years of the Children's Advertising Initiative, we worked together, Rodney's group and my group and Will's group, to do an assessment of what was coming out there, and we had interacted with them and given them our view of that. You're right. At that stage, it was pretty easy to sort of be compliant, we'll say, in the sense that you just had to have really one thing saying you had content. What has happened, of course, is that they have announced that they have stricter criteria that will take effect at the end of this particular year, so we're certainly hopeful that this will actually be much more in line. It's not that they were incorrect in the sense that they made sure that there was some sort of criteria that they were satisfying, but one has to look at the breadth of the different criteria and incorporate that into what makes it through. The new criteria that they have put forward are stricter, we'll say, and hopefully the products that come through will hopefully be healthier as well. But we will be monitoring that as well and trying to do the analysis on that and interact with them as appropriate.
Senator Seidman: Does Health Canada have the ability to outright ban advertising to children?
Dr. Hutchinson: I would have to come back to you on that one.
The Chair: Could you provide that to the clerk?
Dr. Hutchinson: I'm hesitant to say one way or the other at this particular point.
The Chair: We got that. Thank you.
Senator Raine: I want to go back to fat. We heard from some witnesses that for people who have metabolic syndrome, it's healthier for them to eat a high-fat, low-carbohydrate diet. We know that since probably the 1980s, the public has been informed through many channels that if you're overweight, you should be eating a low-fat diet. How are we going to inform the public that a low-fat diet is not healthy for people who are overweight, if that is in fact science?
Dr. Hutchinson: You're right. There has been a lot of information in the news, we'll say, that has sort of been questioning whether one should be going to a lower-fat diet. Really, the totality of the evidence out there is still supportive of decreasing the amount of saturated fats in your diet with respect to health across the board. Now, where there has been a problem or a clarification comes, what do you replace it with? What seemed to have happened back in the 1980s and the 1990s is that the lower-fat messaging then got converted into the creation of foods that had lots of added carbohydrates and sugars, but because they were lower fat they were put forward as being healthier, and that's where the real problem comes. In our guidance, we're always telling people lower in fat and in sugar and in sodium, so you have to be looking at those in concert. The best evidence right now is about having lower saturated fats, but it all has to do with what you're replacing it with. If you replace it with polyunsaturated fats, then you are reducing your relative risk for cardiovascular disease, and the evidence is quite clear on that. If you are replacing it with foods that have sugars instead of polyunsaturated fats, then you're not having any effect with respect to relative risk on things like cardiovascular disease.
Part of the fat message that was there was also not with respect to its effects on different cardiovascular diseases but from the point of an obesity thing in terms of trying to decrease the amount of calories that people were putting out. This is an area that has come up with our evidence review as well in terms of how people are understanding the guidance that is out there. Again, from a scientific point of view, I'll repeat one more time that decreasing the amount of saturated fats is the right thing to do, but it has to do with the replacement of those fats. You can't just all of a sudden put in a lot of sugars to replace those saturated fats. It's the nuancing of the message that has been misunderstood, and we have not been clear enough with respect to the message on that as well. Certainly going forward we will work at better ways to get Canadians to understand the message around fats.
Ms. Bernier: Based on the information we collected in 2004 in our big nutrition survey, and it's based on a lot of respondents, we looked at the profile of sugar, fat, fibre and protein that people intake and compare by weight group, like healthy, obese, overweight, and the profile of what they were eating is the same. The difference was the calorie intake. So it was all about taking 20 per cent more food than someone else, not the composition of the plate.
The Chair: Composition versus the amount. Thank you.
Senator Enverga: We're trying to be clear with our labelling. You mentioned earlier that trans fat is not a good fat. Its unhealthy and a bad fat. Instead of labelling it "trans fat," why not just call it "bad fat" so people really understand it?
Mr. Yan: The nutrition facts table is supposed to be based on scientific information. "Good" and "bad" are very qualitative. While it's probably easier to understand, it doesn't really stand up to the scientific scrutiny that the table has to answer to. That's probably the best answer I can give. I hear you that from an understandability standpoint, that would be a good thing to do, but scientifically it would be hard to say just "good" or "bad."
The Chair: Speaking of good and bad, I want to come back to the issue of trans fat. Some natural, unprocessed foods contain trans fat. The "trans" refers to the configuration about a double bond in the fatty acid side chain on a lipid. Is it correct that most of our systems have the capacity to degrade that trans fat, the one from natural sources unprocessed, without any obvious harm to our system?
Mr. Yan: To clarify, when you say "degrade," do you mean break it down?
The Chair: To use it. If you consume it in natural foods, is there any residual harm to us?
Mr. Yan: No. There is an acceptable level of trans fat consumption.
The Chair: I am referring now only to trans fat, and I have a secondary question. My understanding is that that is not generally harmful to us, within reasonable amounts. If you ate nothing but that, perhaps there would be. Is it also my understanding that the position of the double bond in trans fats that arise from processed foods is in a different position in the carbon chain. Is that correct?
Mr. Yan: Yes. There is some very recent research that is trying to look at the difference between natural trans fat and industrial trans fat and whether there are actually either potential adverse effects or benefits. The data are not that clear-cut. The Dairy Farmers of Canada was doing a lot of research on that.
But the bottom line is that the World Health Organization recommends that if you take in trans fats that are at a level of 1 per cent or less than your total energy intake, there are no adverse health effects. That's what we're targeting for the population intake — if they can maintain 1 per cent or below of trans fats, then it should not be a health hazard.
The Chair: I want to come back to my question: It is correct — and you would confirm my understanding — that the position on the double bond on the side chain — and that we have much more difficulty consuming that material without health effect as opposed to the trans fats that occurs naturally and unprocessed; is that correct?
Mr. Yan: I don't think the evidence is that clear-cut yet. There is still a lot of research going on in that area with regard to exactly what the differences are between the types of trans fat and the overall health outcome.
The Chair: If we have reached the point that we conclude that trans fats are a hazard, that we should reduce them, we must have concluded that certain trans fats are a problem for us. And if we have also concluded that the amount in natural materials is not of a sufficient level to cause us harm, then the problem arises from the trans fats occurring through the processing of food; does it not?
Mr. Yan: It's not a simple "yes" or "no" answer to the question, unfortunately. We all agree that trans fats should be reduced to a minimum level.
The Chair: I want to get to other questions. You are not answering my question directly. I will leave that to stand on the record.
Senator Merchant: Ms. Aubin, you said that closeness of a school to the grocery stores — what about in supermarkets? What about arranging supermarkets differently so that you have a section that is the healthy food section? When you go into a supermarket now, everything is together — pharmacy — it's confusing. They're very large.
Have you ever thought of maybe — you're arranging how the plates should look, but what about the environment that families are faced with? If you go into a supermarket, what about having sections so that a person knows if there is shopping — instead of blue and yellow labels, what about an alternative?
Ms. Aubin: Thank you for the question and the idea. I'm not aware of studies that CIHR is funding that have looked specifically at the idea that you're raising about grocery stores. One of my colleagues might know.
But we are funding a variety of studies now related to various aspects of how the built environment — and I would consider your question about grocery stores as "the built environment effect" — has an intervention with obesity.
I will check to see whether we are directly funding anything of the sort that you're talking about, but it's a very interesting idea that can be discussed at the various stakeholder meetings that we bring together.
Dr. Hutchinson: I had mentioned in my introductory remarks that we're doing a fair amount of work on looking at food environments and how to help people make healthier choices. We have been doing work in the school and home food environment to look at food skills, but where we have been putting emphasis recently has to do with the retail environment.
The Public Health Agency of Canada and we are co-funding some work and evaluations with Toronto Public Health where they're looking at lower socio-economic areas and examining how to create a healthier convenience store, and the impact of using mobile buses to bring out fruits and vegetables. There are a number of different studies that we have been working on with Toronto Public Health in terms of the placement of healthier products in stores; what sorts of promotional strategies you need so people will choose that; and then, in the last month, we've had a number of workshops to figure out how to make that sustainable for the small convenience retailers.
The sorts of things that have come up from our workshops have been that if you can increase the buying power of these individual mom-and-pop convenience stores through a fruit-and-vegetable buying club type of arrangement — and there has been some experimentation of this in the Toronto area — they can make their profit and you can have the access for fruits and vegetables.
As well, we have recently expanded that and worked with Eastern Health in Newfoundland and Labrador to take the lessons that Toronto Public Health has done and take that into remote and rural type of settings, so we're working with Memorial University and Eastern Health in Newfoundland and Labrador — we're not doing this; to be clear, we're supporting this as part of the evaluation but also supporting the innovation and giving advice on how to do this. But we are looking at mapping the different sorts of convenience stores and trying to figure out what to introduce from what we have learned from Toronto into a rural remote situation.
I agree with you completely. This is a tremendously important aspect of making it easier for people to make healthier choices. You can drill into them all the dietary guidelines and all the messages, but if they don't have access to those foods, it's not going to do much good. That's why we are very clear that we work on policy interventions as well to try and make the food environment a healthier place.
The Chair: This has been interesting. We have heard from a number of witnesses that natural foods that have not gone through any industrial processing don't need a warning label. They're not referring to those things that may contain something that is a hazard to your health. Although natural things do contain hazards, that's not what they're referring to. They're talking about, in general, the issue of a food guide, which means that processing, whether it's the deliberate addition of carbohydrates or sugars in replacement of something else, or the actual thermal treatment of foods in the processing, does bring about changes that can have an impact on health.
It seems to me that the question I asked on the position of the double bond on the side chain between natural and processed foods is an issue that Health Canada should be looking at, and through a clearly designed trial. I agree with Dr. Yan that the comments in various literatures lead to confusion. I do not believe there has to be confusion. It is my opinion that question can be answered.
However, it's not the purpose of this committee to order clinical trials on specific issues. But we're dealing with a complex problem here, and we will attempt to provide a report that we hope will be of benefit to Canadians.
I want to thank my colleagues for their insightful questions over the course of this study that have elicited a lot of responses, some of which we may be able to use. It has given us an understanding of the challenges in this whole area of diet, health and activity.
The complexity of the human animal in its environment is one that doesn't lead to an easy regulation on the part of government. In the face of all of that, we have to try to come up with a sensible report that will be of some help to Canadians.
Thank you all for being here today.
I am about to suspend the meeting, and I want to advise the audience that I'm asking you to clear the room immediately. The next session is in camera. My colleagues sometimes like to talk to witnesses at the end, and if you do, please take it outside. I'm going to gavel the meeting back into an in camera session as soon as the room is cleared.
(The committee continued in camera.)