Question Period Note: Healthy living and obesity

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• Levels of obesity in Canada, particularly among children, remain high, bringing both immediate and long-term health risks. Rising costs of living, including food costs, have posed additional barriers to healthy living for many families. Further, obesity-related stigma remains a concern, with negative impacts on physical and mental health.
• This Government recognizes the importance of promoting healthy weights, particularly among our children and youth, to help prevent chronic diseases and other health problems, including those that occur later in life. Active and healthy living yields positive impacts on both physical and mental health; conversely, obesity-related stigma can contribute to negative impacts on children and youths’ physical and mental health.
• The pandemic has made it more challenging for many children and families to engage in healthy, active living. Factors like disrupted routines (for sleeping, eating, etc.), online learning context and limited access to school and community sports and leisure programming are among the unique contributors.
• Our Government, along with the provinces and territories, is working with the not-for-profit and private sectors to help children, youth and families to adopt and maintain healthy behaviours, like physical activity and nutritious patterns of eating. At the same time, we are working to curb weight-related stigma, which is pervasive and represents a public health problem in its own right.
• We are also supporting community-based initiatives that promote the health of young families and their children to improve overall child health and wellbeing, and promote healthy living and help prevent chronic diseases of all Canadians.

Individuals’ body sizes and weights are influenced by a wide range of individual, community and society-level factors. Some factors are somewhat within an individual’s control (e.g., physical activity, diet, etc.), though many are not (e.g., accessibility of healthy food, built environment features in their community, genetics, health conditions, etc.)

Before the pandemic, one in three Canadian children and youth were overweight or obese, with rates even higher among Indigenous children. Increasingly, obese children are being diagnosed with a range of health conditions previously seen almost exclusively among adults, such as type 2 diabetes, high cholesterol, high blood pressure, sleep apnea and joint problems.

Early data since the pandemic suggests significant changes in youth physical activity and sedentary behaviour levels. Based on preliminary Statistics Canada data collected in fall 2020, the percentage of youth aged 12-17 who reported meeting physical activity recommendations fell significantly from 50.8% in fall 2018 to 37.2% in fall 2020. This is reflected in a drop of seven minutes in average daily minutes of recreational physical activity and a drop of 12 average daily minutes of school-based physical activity.

Evidence from ParticipACTION suggests even greater increases in screen time during the pandemic. In a national survey, ParticipACTION found that approximately one in ten children were meeting screen-time recommendations during the pandemic. This compares to the approximately five in ten children reported in PHAC’s Physical Activity, Sedentary Behaviour and Sleep Indicators in the 2018/19 Canadian Health Measures Survey collected prior to the pandemic.

Further data will become available to analyse in the fall of 2022.

Relevant to discussions of healthy living and weight is weight bias, which is stigma and discrimination on the basis of body size and weight. Weight bias is highly prevalent in our society, and impacts people of all ages. One way that weight bias manifests for children and youth is bullying on the basis of weight, which includes verbal abuse and social exclusion.
Healthy Living Programming
The Public Health Agency of Canada (PHAC) supports community-based initiatives to improve healthy behaviours and address health inequalities among priority populations at greater risk of developing chronic disease. In particular, PHAC’s Healthy Canadians and Communities Fund (HCCF) invests approximately $20 million annually and leverages additional funding from partners to support projects that focus on the behavioural risk factors, including physical inactivity, unhealthy eating and tobacco use, associated with the major chronic diseases of diabetes, cardiovascular disease and cancer. Among the many projects funded by HCCF includes 24 hour movement guidelines for the Early Years (0-4) and Children and Youth (5-17).

PHAC also provides funding for community-based programs aimed at promoting the health of pregnant people, young children and their families. Targeted to populations facing barriers to health equity, these programs support a healthy start in life by promoting overall child health and wellbeing. This includes the promotion of healthy weights through programming related to nutrition, healthy eating and food skills, food security, breastfeeding support, physical activity and mental health promotion.

• These programs include:
Community Action Program for Children (CAPC) provides $54.1 million in annual funding to community-based groups to develop and deliver comprehensive, culturally appropriate prevention and early intervention programs for vulnerable children aged 0-6 years. Through approximately 400 funded projects, CAPC reaches over 225,000 participants across Canada each year. CAPC participants report improved parental capacity, child physical and mental wellbeing, social competence and overall healthy development.

• Canada Prenatal Nutrition Program (CPNP) provides $26.5 million in annual funding to community-based groups to improve the health of vulnerable pregnant people and their infants. Through approximately 240 funded projects, CPNP serves over 45,000 participants across Canada each year. CPNP participation is associated with higher rates of breastfeeding, improved prenatal vitamin supplement intake, reduced smoking and alcohol consumption, and improved maternal and infant physical and mental health.

• Healthy Early Years (HEY) provides $2.2 million annually to enhance early childhood health promotion programming in Official Language Minority Communities (OLMC). The objective of the HEY program is to support communities to develop comprehensive, culturally and linguistically appropriate programs aimed at improving the health and development of children (0-6 years) and their families living in OLMC. HEY funding is distributed to community organizations through two recipients, one serving the minority francophone population outside of Quebec and the other serving the minority Anglophone population in Quebec.

• Aboriginal Head Start in Urban and Northern Communities (AHSUNC) provides $32.1 million in annual funding to Indigenous community-based organizations to deliver early intervention programs for Indigenous children and their families living off-reserve. In addition, through recent incremental investments in the Indigenous Early Learning and Child Care initiative, the AHSUNC program will receive an additional $122.9 million over the next five years, with an ongoing funding commitment thereafter to bolster and expand program delivery and site conditions in urban and northern communities. AHSUNC serves approximately 4,600 Indigenous children in 134 sites across Canada each year. Program evaluations indicate the AHSUNC program is having a positive effect on school readiness, improving children’s language, social, motor and academic skills. Results also indicate program effectiveness in improving cultural literacy and health promoting behaviors, and improving access to health services for Indigenous children and their families.

• As a complement to the Nutrition North Canada (NNC) retail food subsidy, the NNC Nutrition Education Initiatives component provides funding to eligible northern isolated communities to deliver culturally appropriate and community-based nutrition education activities. Funding is administered by Indigenous Services Canada (ISC) and PHAC (for the 10 non-First Nations and non-Inuit communities that fall outside of ISC’s mandate).

• The School Health Grant for Youth provides youth aged 13-19 who are enrolled in grades 9-12 the opportunity to apply for small grant funding ($1500, $2500, or $3500) to develop and implement projects and initiatives that promote healthy living in their schools. Youth-led projects must align with at least one of the following four priorities: healthy eating and nutrition; physical activity; positive mental health and well-being; substance use and related harms. Youth can also consider developing projects that address COVID-19-related issues, as long as their project still relates to one or more of the four priorities listed above. This program anticipates providing 20-40 youth grants during its 2022-23 cycle.

Improving data availability
PHAC monitors behaviours and factors that impact healthy living through the Physical Activity, Sedentary Behaviour and Sleep Indicators Framework and the Canadian Chronic Disease Indicators. As new data collected during the pandemic become available, including through the PHAC-funded Health Behaviour in School-aged Children study, the Canadian Community Health Survey and other relevant national surveys, these indicators will help better describe the impact of the pandemic, including the loss of active travel to work/school and self-isolation restrictions, on the movement behaviours of Canadians.
Prior to the COVID-19 pandemic, there were already critical data gaps related to children and youth. As efforts are enhanced to collect timely and comprehensive data for these populations, PHAC focuses on ensuring the data collected can adequately describe the longer-term impacts of COVID-19 and that the information can be disaggregated for specific populations, including diverse children and youth as well as those in vulnerable situations (e.g., low-income communities).

In partnership with Statistics Canada, the Canadian Institutes for Health Research (CIHR) and the Offord Centre for Child Studies at McMaster University, PHAC is working at developing the second cycle of the Canadian Health Survey in Children and Youth (CHSCY). The survey will cover a broad range of topics, including healthy living and healthy weights, as well as wider health impacts of COVID-19. This new cycle of the CHSCY will address a critical data gap around data on children and youth and will be available in early 2024. PHAC’s investment in the second cycle of CHSCY will be $4.55 million over three years (2021-22 to 2023-24).

In addition, PHAC leads the Pan-Canadian Health Inequalities Reporting Initiative (HIRI) to strengthen the measurement, monitoring and reporting of health inequalities in Canada to help inform healthy living programs and policies that target priority population groups.

Other related initiatives
The Framework for Diabetes in Canada (Framework) was tabled by the federal Minister of Health on October 5, 2022 in response to the National Framework for Diabetes Act, which passed in June 2021. The Framework aims to provide a common policy direction to address diabetes in Canada, including for populations at elevated risk of developing diabetes, people living with diabetes and their caregivers, Indigenous populations, non-governmental organizations, health care professionals, researchers, and all levels of government. It lays the foundation for collaborative and complementary action by all sectors of society to improve access to diabetes prevention and treatment, and ensure better health outcomes for people living in Canada.

Announced in October 2016, the Healthy Eating Strategy aims to improve the food environment in Canada to make it easier for Canadians to make the healthier choice. Since the launch of the Healthy Eating Strategy, Canada has revised Canada’s Food Guide and introduced a ban on industrial trans fats. Health Canada also developed updates to the Nutrition Facts table and ingredient list on packaged foods. In addition, the Healthy Eating Strategy includes initiatives to improve nutrition labelling and restrict advertising of certain foods and beverages to children.

On January 27, 2022, Infrastructure Canada opened applications for the $400 million Active Transportation Fund, which will invest in such projects as building new and expanded networks of pathways, bike lanes, trails, and pedestrian bridges. This funding has the potential to significantly increase physical activity levels among Canadian children, youth and adults by improving opportunities for active transportation.

In 2020, the Minister of Health launched Wellness Together Canada, a mental health and substance use portal that provides Canadians with free physical activity resources and support, including information on maintaining a healthy lifestyle, and access to peer support workers, social workers, psychologists, and other professionals.

• Before the pandemic, levels of obesity in Canada remained high with one in three children and two out of three adults considered overweight or obese.
• Initial findings suggest that youth physical activity levels fell significantly during the COVID-19 pandemic, particularly recreational and school based activity. Also, evidence points to a significant rise in screen time for children and youth.
• Dissatisfaction with one’s weight or shape and unhealthy relationships with food and physical activity can contribute to disordered eating (e.g., unhealthy eating behaviours, like binge eating, restrictive eating, meal skipping to lose weight, etc.) and eating disorders (i.e., disorders which involve a clinical diagnosis; reflects more severe or chronic disordered eating). Eating disorders, such as anorexia nervosa, are serious mental illnesses with significant morbidity and mortality. Disordered eating and eating disorders affect individuals of all body sizes.
• National-level Canadian Institute for Health Information data published in early May 2022 show that hospital visits for eating disorders increased nearly 60% among girls aged 10-17 years in the first year of the pandemic, a time in which hospital care overall decreased. Those living in less-affluent neighbourhoods had higher rates of emergency room visits and hospitalizations for mental health overall. This was reversed for hospital care for eating disorders — those living in the most-affluent neighbourhoods had higher hospitalization rates, suggesting greater access to treatment and care.