Senate committee hears about critical nature of childhood obesity rates in Canada

On May 6^th, Dr. Catherine Pound, member of the CPS Nutrition and Gastroenterology Committee, spoke on behalf of the CPS at the Social Affairs, Science and Technology Senate Standing Committee meeting. Dr. Pound spoke to senators about the increasing incidence of obesity in Canada, specifically in children. She shared her remarks with us.

Thank you for the opportunity to present at this committee. The Canadian Paediatric Society recognizes the critical nature of the overweight and obesity epidemic in Canada. Canada has one of the highest rates of childhood obesity in the developed world, ranking 6^th out of 34 OECD (Organization for Economic Cooperation and Development) countries¹. According to the WHO cutoffs, close to 20% of 5 to 17 year old Canadians are overweight, and almost 12% are obese².  These numbers are even higher in vulnerable populations, especially in children of Aboriginal descent.

This issue of overweight and obesity places a significant strain on the health care system. In 2008, the economic costs of obesity were estimated at $4.6 billion, based on costs associated with chronic diseases linked to obesity³. Paediatricians now see children developing comorbidities that were once mostly seen in adults, including insulin resistance, type 2 diabetes, and hypertension. Excess weight in youth has also been linked to poor emotional health, decreased self-esteem, and diminished social wellbeing. Our overweight and obese youth will become overweight and obese adults, if we do not intervene. Given the challenge of reversing overweight and obesity once it is established, it is essential to highlight the importance of preventive strategies. 

The overweight and obesity problem is multifactorial. It is impacted by genetic, economic, cultural, environmental, nutritional and physical activity factors, and shares correlation with the socioeconomic determinants of health.

Sustained changes to current behaviours and societal environments are needed to bring into balance the caloric intake: energy output equation.

Few children consume the recommended amount of fruits and vegetables daily. Access to healthy foods is a challenge for children of low-income families, as the cost of nutritious foods is too often prohibitive. Obesity and food insecurity are closely linked, and in 2012, 1.15 million children in Canada were estimated to live in households experiencing some degree of food insecurity⁴.

The lack of physical activity also clearly factors in the equation. 93% of children aged 5 to 11 and 96% of children aged 12 to 17 do not meet the Canadian Physical Activity Guidelines⁵ of 60 minutes of moderate to vigorous physical activity daily.

Similarly, less than 20% of 3 to 4 year-olds and 10 to 16 year-olds meet the Canadian Sedentary Behaviour Guidelines for Children and Youth, which recommend daily screen time of no more than 1 hour for the younger age group and no more than two hours for the older one⁵. This is important, as children participating in over two hours of screen time daily were found to be twice as likely to be overweight and obese, as compared to children exposed to an hour or less.

It is likely that significant change will require the input of multiple stakeholders, with the aim to empower individual accountability. Such interventions are likely to include increased education and awareness of the impact of overweight and obesity on health and disease, as well as identifying healthy behaviours that will protect against the development of obesity. Important stakeholders need to include individual Canadians and families, health care systems, schools, work environments, food industry and governments.

Preventive strategies need to be explored, and developed. Policies and legislations have the potential to facilitate the development of healthy environments and communities; though such interventions have to be sensitive to customs and individual choice. Care must be taken to ensure that those policies and legislations do not negatively impact vulnerable populations.

Strategies starting as early as the neonatal period should be encouraged. For instance, nationwide breastfeeding support programs could be considered, given the protective effect of breastfeeding against overweight and obesity. Food and beverage advertising to children should be examined, given its potential to contribute to childhood obesity. The development of programs aiming to increase physical activity levels and improving access to community recreational facilities needs to be considered. In addition, education and social awareness campaigns are essential to disseminate a strong and unified message to the Canadian population.

The setting of goals and the implementation of monitoring programs to examine the impact of interventions is critical. Ongoing research on the determinants of overweight and obesity development, as well as on effective solutions should be strongly supported.

The Canadian Paediatric Society shares the hope that sustained, thoughtful and collaborative interventions will be developed, with the concrete goal of decreasing overweight and obesity, as well as the burden of disease associated with it, in our Canadian youth.

References

1. Obesity update. OECD. June 2014. Accessed May 4^th 2015: http://www.oecd.org/els/health-systems/Obesity-Update-2014.pdf
2. Roberts KC, Shields M, de Groh M, Aziz A, Gilbert JA. Overweight and obesity in children and adolescents: Results form the 2009 to 2011 Canadian Health Measures Survey. Statistics Canada, Catalogue no. 82-003-XPE. Health Reports 2012; 23 (3)
3. Obesity in Canada. A joint report from the Public Health Agency of Canada and the Canadian Institute for Health Information, 2011. Accessed May 4^th 2015: http://www.phac-aspc.gc.ca/hp-ps/hl-mvs/oic-oac/assets/pdf/oic-oac-eng.pdf
4. Tarasuk V, Mitchell A, Dachner N. Household food insecurity in Canada 2011. Research to identify policy options to reduce food insecurity (PROOF); 2013. Accessed May 4^th 2015: http://nutritionalsciences.lamp.utoronto.ca/resources/proof-annual-reports/annual-report-2012/
5. Active Healthy Kids Canada (2014) Is Canada in the Running? The 2014 Active Healthy Kids Canada Report Card on Physical Activity for Children and Youth. Toronto: Active Healthy Kids Canada

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