Study on Childhood Obesity

Transcription

1 NOTES FOR AN ADDRESS BY Dr. Colin J. McMillan President Canadian Medical Association Study on Childhood Obesity Presentation to the House of Commons Standing Committee on Health Ottawa, Ontario October 19, 2006 A healthy population a vibrant medical profession Une population en santé une profession médicale dynamique

2 The Canadian Medical Association (CMA) is the national voice of Canadian physicians. Founded in 1867, CMA s mission is to serve and unite the physicians of Canada and be the national advocate, in partnership with the people of Canada, for the highest standards of health and health care. On behalf of its more than 64,000 members and the Canadian public, CMA performs a wide variety of functions, such as advocating health promotion and disease/injury prevention policies and strategies, advocating for access to quality health care, facilitating change within the medical profession, and providing leadership and guidance to physicians to help them influence, manage and adapt to changes in health care delivery. The CMA is a voluntary professional organization representing the majority of Canada s physicians and comprising 12 provincial and territorial divisions and 45 affiliated medical organizations.

3 Canada can do better Introduction Obesity and physical inactivity are two of the gravest health problems facing children in Canada today and we commend the Committee for taking on this important study. The rate of childhood obesity in Canada is unacceptable. Simply put we are failing our children. Canada can and must do better. The rate of childhood obesity in Canada continues to grow and in fact today that growth exceeds most of the developed world. While the facts may no longer surprise you, what may is the attitudes of Canadian parents who are in denial about their own children s health. In a recent Ipsos-Reid survey commissioned by the CMA, only 9% of parents identified their children as overweight or obese. However, we know in reality well over 26% of Canadian children are overweight or obese. This denial poses a significant challenge to educate Canadian parents but it poses an even great risk to the health of Canadian children. My remarks today are a distillation of the CMA s general policy position statement: Promoting Physical Activity and Healthy Weight. We have attached copies of this document to this presentation for your reference. Our policy document highlights what can be done by individuals and families, schools and communities to promote physical activity and fight obesity. However, I understand that this Committee is looking for specific recommendations on what the federal government can do in the area of childhood obesity and thus I will focus my remarks on the federal role. I must point out, however, that a strategy on healthy eating and physical activity must focus on both children and adults, since the factors that have created our obesity epidemic are societywide. First and foremost today, I want to make it clear that a comprehensive strategy is needed to combat the epidemic of obesity that threatens our nation. Canadian Medical Association Ottawa, October 19, 2006 Page 1

4 This strategy requires action from all levels of government and involvement and participation of all relevant stakeholders. Within the strategy, the federal government has three key and distinct policy levers it can use to address the scourge of obesity: Economic Communication Regulatory Economic Lever Canada can, and should do better. We should follow the lead of several other countries that use fiscal measures to promote availability of and access to healthy foods. Addressing childhood obesity requires that we all take steps to encourage Canadian families to incorporate healthy eating and physical activity into their daily lives. However, eating healthy doesn t always come cheap. In some parts of Canada, fresh food may not be available or may be priced out of many people s reach. Yet, you can be sure that high-calorie, nutrient-poor junk food is available everywhere for relatively little cost, prominently displayed in fast-food restaurants and convenience stores. Similarly, we could also follow the lead of other nations that use taxes to influence food consumption, or countries that use public funds and subsidies to promote access to recreational and sporting facilities in under-serviced communities. What is important is that there is no one simple answer. There s no drive-thru and order option. In fact, the CMA thinks Canada needs to examine all options. Recently, the CMA participated in a government forum on using selective tax credits to promote or provide an incentive for physical activity. We suggested three main themes for the expansion of such credits: First, tax credits for physical activity should be broad in scope and not limited to organized sports alone; Second, tax credits should target community-based programs that promote physical fitness in at least 1 of the 3 activity groups of Canada's Physical Activity Guide namely: endurance, flexibility and strength; Third, tax credits must help those most at risk. Many low-income Canadians do not pay taxes, and therefore might not qualify for a tax credit. The Fitness Tax Credit must not become only a middle-class solution. Finance Canada should consider making it a refundable credit, like the GST rebate. Canadian Medical Association Ottawa, October 19, 2006 Page 2

5 A tax credit for physical activity is one example of an economic policy that, in this case an incentive-based program, could address obesity. Governments also need to use tax incentives to remove barriers and promote access to healthier foods. In targeting the use of incentives to remove barriers to healthy food and physical activity, tax disincentives the flip side of the incentive coin must not be overlooked. Using tax disincentives to encourage healthy eating is not a new or extreme concept. In fact, the World Health Organization first proposed in 2003 that nations tax junk foods to encourage people to make healthier food choices. The American Medical Association is set to soon demand that the federal government levy heavy taxes on the America's soft drinks industry. Currently, 18 U.S. states have some form of "snack" food tax in place and five states have proposed policy and legislative recommendations. Here at home, both British Columbia and Quebec governments have recently expressed interest in some sort of junk-food tax. In Canada our lives are full of disincentives to promote making healthy choices, taxes on tobacco products being the biggest and most successful example. Yet even though these measures are proven effective by falling smoking rates, critics of these measures continue to bray from the sidelines calling these policies social engineering. It s a specious argument at best. Canada is a world leader in tobacco control and it is past time that we show the same leadership when it comes to controlling obesity, especially childhood obesity. Communication Lever Another federal policy lever that could be used to combat obesity is Canada s Telecommunication and Broadcasting regulations and policies. The average North American child is exposed to some 40,000 food advertisements a year, most of them for high-calorie, nutrient-poor junk food. Billions of dollars are spent each year in North America on junk-food advertising specifically directed at children. Recently, researchers in the US concluded that fast-food ads on television contribute significantly to this childhood obesity epidemic. Canadian Medical Association Ottawa, October 19, 2006 Page 3

6 This same research estimated that a total ban on fast-food television advertising could cut the number of overweight children (ages 3 to 11) by 10 per cent and the number of overweight adolescents (ages 12 to 18) by 12 per cent. Countries such as Sweden have long banned food advertising aimed at children and have much lower levels of childhood obesity. Quebec has similar prohibitions which have also led to positive results. Again, this is another area where we can do better. The government of Canada already regulates advertising of many products in the public interest, notably restrictions on prescription drug advertising, alcohol and tobacco products. Given the extreme and growing health burden obesity is having on the health of Canadians, advertising of high calorie and nutrient-poor food should be restricted in the same manner as tobacco, alcohol and prescription drugs. We would also call upon federal government to restore funding for public campaigns such as ParticiPACTION which encouraged Canadians be active and promote a healthy lifestyle. Public education must be a central element in any comprehensive strategy. Regulatory Lever The final area I will touch on today is how the federal government can put the information Canadians need to fight obesity right under their noses, literally. I m talking about the need for the federal government to use its regulatory authority under the Food and Drug Act to require appropriate labelling. An educated consumer is one of our best defences against obesity. However, Canadians don t have all the facts they need to make informed decisions about their food choices. Health Canada has recently improved product labelling requirements, but far too many Canadians are still exposed to potentially misleading nutritional information, particularly in advertisements or promotional material. Health claims made for food should be strictly regulated to ensure that they are based on the best available scientific evidence, and are accurately communicated to consumers. Food advertisements should be pre-cleared before airing in the media, and the provisions against deceptive advertising in the Food and Drug Act should be strengthened. Brand-specific advertising is a less than optimal way of providing health information to consumers and we owe it to Canadians who are seeking quality, objective information about healthy eating to provide them with this valuable information. Labeling is another area where we can do better. Canadian Medical Association Ottawa, October 19, 2006 Page 4

7 We need more programs where health professionals, industry and governments work together in the interest of informing and educating consumers. Conclusion So in conclusion, I want to stress that when it comes to the health of our children, governments must use every policy lever at its disposal. Former US Surgeon General, C. Everett Koop, noted recently that obesity trails only smoking as the number one cause of preventable death, yet government policies are not targeting the problem as they have with smoking. We must recognize that obesity, especially childhood obesity, presents us with a public health threat possibly comparable to the threat of tobacco use. And we must attack the scourge with the same resolve. Governments have a critical role to play in helping their citizens make healthy choices: First, all levels of governments, in cooperation with relevant stakeholders, must develop, implement and maintain a comprehensive approach. One-off policies do not work; Second, as I have outlined, governments have policy levers at their disposal. They must be bold enough to show leadership and use them; And finally, education of the population and denormalization of unhealthy behaviour is the key. The more Canadians know, the more they are empowered to make positive decisions. Before I finish my remarks today I would be remiss if I didn t speak about the unique challenges faced by our aboriginal populations. Over 60% of aboriginal children are overweight or obese. Any efforts to combat childhood obesity, particularly any federal government efforts, must take into consideration the urgent and special needs of this population. Again, we congratulate the Committee for undertaking this study and for looking at ways that we can do better for Canadian children. We hope this study will form part of a continuous and ongoing effort by the Government of Canada on the issue of childhood obesity that will lead to action and results for Canada families. Thank you. Canadian Medical Association Ottawa, October 19, 2006 Page 5

8 CMA POLICY Promoting Physical Activity and Healthy Weights Introduction Exercising daily and following a nutritious diet are two of the most beneficial things people can do for their health. Despite this fact, overweight and obesity, which are related to unhealthy diet and lack of physical activity, and excessive calorie intake relative to energy output, are a growing problem in this country. If not addressed, they could have serious consequences for Canadians: a heavy burden of death and disease, reduced quality of life and a financial strain on the health care system. Determined action is required. The epidemic of overweight and obesity can be mitigated by making it easier for Canadians to incorporate healthy eating and physical activity into their daily lives. This is a task in which everyone can play a part: individual Canadians, their schools and communities, their governments and industry, as well as doctors and other health professionals. Physicians, who see the consequences of unhealthy eating and physical inactivity regularly in their practices, are anxious to work with others on such a task. In this statement, the CMA outlines specific steps that can be taken to promote physical activity and healthy weight. The burden of physical inactivity and unhealthy weight in Canada The growing problem of obesity Nearly a quarter of Canadians are obese (defined as body mass index [BMI] 30), up from about 10% in the early 1990s. Of particular concern is the obesity rate among young people, which has tripled since 1979; 9% of adolescents were obese in ,2 The rate is higher among some population groups, such as Aboriginal peoples and women on low incomes. The problem is not unique to Canada; obesity rates are increasing worldwide. However, Canada reports one of the highest obesity rates in the developed world. Obesity is a major risk factor for many health problems, including high blood pressure, high cholesterol levels, heart disease and stroke, degenerative joint problems such as osteoarthritis, and certain types of cancers. An obese person s risk of Type 2 diabetes mellitus may be as much as 90 times that of a person of healthy weight. 3,4 The increase in childhood obesity means that diseases once associated with adults are now being seen in children; for example, the number of children with Type 2 diabetes has jumped 15-fold since Obesity costs Canada nearly $2 billion per year, or 2.4% of total direct health care costs. This does not take into account indirect costs such as lost productivity, disability insurance, reduced quality of life and psychological damage due to stigmatization and poor self-esteem. People who are overweight or obese can improve their health and reduce their risk of disease by losing excess weight. However, current approaches to weight loss have done little to curb the epidemic. There is no shortage of information for the consumer who wants to lose weight, but in many cases its merit is unproven. Although popular diets may succeed in the short run, the vast majority of those who lose weight put it on again within a few years. Weight loss drugs are of limited benefit and, like all medications, may have unpleasant side effects. Surgical treatment is generally 2006 Canadian Medical Association. You may, for your non-commercial use, reproduce, in whole or in part and in any form or manner, unlimited copies of CMA Policy Statements provided that credit is given to the original source. Any other use, including republishing, redistribution, storage in a retrieval system or posting on a Web site requires explicit permission from CMA. Please contact the Permissions Coordinator, Publications, CMA, 1867 Alta Vista Dr., Ottawa ON K1G 3Y6; fax ; permissions@cma.ca. Correspondence and requests for additional copies should be addressed to the Member Service Centre, Canadian Medical Association, 1867 Alta Vista Drive, Ottawa, ON K1G 3Y6; tel or x2307; fax All polices of the CMA are available electronically through CMA Online (cma.ca). PD06-03

9 not recommended except for the extremely obese (BMI > 40, or > 35 with a related medical condition). In short, whatever we have done to date has not been enough. What should be done? A problem of modern living To answer this question it may be helpful to look at why rates of overweight and obesity are rising. The cause is generally attributed to the fact that, as a society, we are increasing our calorie intake while at the same time burning less energy in physical activity. Per capita energy consumption has risen by nearly 20% since the early 1990s, from an average 2,300 to 2,700 calories per day, 6 and over half of Canadians 12 years of age and older are physically inactive. 1,2 These developments are most likely related to major cultural and technological changes in the past few decades and their effect on the way we live. For example, high-fat, high-calorie fast foods are easily available for relatively low cost; many people work in sedentary jobs, to which they commute by car; the sprawling suburban communities, in which many Canadians live, with their multilane highways and bigbox shopping malls, do not encourage walking or cycling; leisure activities among children have shifted from active games to more sedentary pursuits. The average Canadian child spends about 14 hours per week in front of the television; this does not include time spent on video games and the computer; and much of the food served in schools is high in calories and low in nutrients. In addition, because of budget constraints, the time spent on physical education and sport has been reduced over the past few years in many Canadian schools. What can be done? Experts believe that just as the epidemic of overweight and obesity has many causes, combating it should involve a variety of solutions gathered into a comprehensive strategy. The aim of this strategy should not be to blame or stigmatize people who are overweight or obese, but to create conditions that make it easy for Canadians to incorporate healthy eating and physical activity into their daily lives. This comprehensive approach is at the heart of the World Health Organization s Global Strategy on Diet, Physical Activity and Health, 7 approved by the World Health Assembly in May Below are the CMA s recommendations for applying this approach in Canada. A Canada-wide strategy Recommendation 1 The Canadian Medical Association calls on federal, provincial, territorial and municipal governments to commit to a longterm, well-funded Canada-wide strategy for healthy living. Recommendation 2 The Canadian Medical Association calls on all stakeholders to develop, as an urgent priority, an action plan to address the obesity epidemic in Canada, with the goal of increasing by 15% within 10 years the proportion of Canadians who are at a healthy weight. Recommendation 3 The Canadian Medical Association urges all levels of government to commit to a strategy for increasing the physical activity levels of all Canadians, with the target of a 10% increase in each province and territory within 10 years. A national strategy should include: information and support for Canadians to help them make healthy choices, including support for physicians and other health professionals in counselling patients on healthy weight and in treating existing obesity; community infrastructures that make healthy living easier; and public policies that encourage healthy eating and physical activity. As a first step, Canada s federal, provincial and territorial governments should approve these or other national targets and agree to work toward them. Canada s governments have already acknowledged the need to move forward on this issue. In October 2005, federal, provincial and territorial ministers of health endorsed a Healthy Living Strategy framework, whose initial priorities include the promotion of healthy eating and physical activity. This framework should be further developed with a view to implementation over the long term. A role for everyone Every Canadian has a potential role to play in promoting physical activity and healthy weights. A national strategy should ensure that everyone has the resources they need to fulfill this role. In particular, the CMA acknowledges the potential contributions of the following sectors: individuals and families, schools, workplaces, communities and the food industry. PD06-03

10 Individuals and families Recommendation 4 The Canadian Medical Association recommends that all Canadians work toward achieving and maintaining a healthy weight by: educating themselves about their dietary needs and about the calorie count and nutrition content of foods; and engaging in physical activity, with the goal of at least 30 minutes of moderate activity per day. Ultimately, healthy eating and physical activity require that individuals take responsibility for making healthy choices in their lives. However, losing weight and increasing exercise are not easy tasks, particularly if they involve changing a lifetime of unhealthy behaviour, and those who have trouble doing so risk perceiving the effort as futile and giving up. Healthy habits are easier to maintain through life if acquired in childhood and encouraged by the family. Therefore, Canadian families should be supported in efforts to ensure that both children and adults eat nutritiously and exercise daily. For example, Resource material that provides Canadians with guidance on healthy eating, physical activity and calorie needs should be widely distributed, in a form that families can easily incorporate into their daily lives. Governments and health care providers should work together to provide consistent information, guidance and support. Parents should ensure that children balance the time they spend on passive activities, such as watching television and surfing the Internet, with time spent in active recreation. Schools Schools can be an important influence on children s eating and physical activity habits. They could, for example, provide comprehensive health and nutrition education, serve nutritious food in their cafeterias and promote physical activity by providing formal instruction and informal recreation time. This does not always happen. In 2001, only 16% of Canadian schools reported that they provided daily physical education classes. 8 To raise needed funds, some schools have signed sponsorship contracts with food manufacturers that oblige them to provide high-calorie, nutrition-poor food to students. As a sign of our encouragement to schools to become a force for health, the CMA recommends the following. Recommendation 5 The Canadian Medical Association calls on school boards to provide at least 30 minutes of active daily physical education for all primary and secondary grades, given by trained educators in the field. Recommendation 6 The Canadian Medical Association recommends that schools provide access to attractive, affordable, healthy food choices and clearly post the nutrition content of the foods they sell. Recommendation 7 The Canadian Medical Association calls on relevant levels of government to ban the sale of high-calorie, nutrient-poor foods in all primary, intermediate and secondary schools in Canada and to initiate programs aimed at encouraging healthy food consumption in schools. Children, particularly those from low-income families who cannot afford recreation fees or sports equipment, may benefit from being able to use school recreation facilities outside school hours. The financial and other barriers that currently prevent after-hours use of school recreation facilities should be addressed. Governments, in particular provincial and territorial governments, should provide financial support to schools to help them implement comprehensive health and physical education programs. Workplaces Recommendation 8 The Canadian Medical Association encourages employers to actively promote the health of their employees by providing access to fitness facilities and healthy food choices in cafeterias. Adults, as well as children, benefit from everyday surroundings that encourage healthy eating and physical activity, particularly as so many Canadians work in sedentary jobs to which they drive rather than walk. The workplace is an ideal environment in which to promote healthy living. A healthy worker has more energy, takes fewer sick days and is likely to be happier and more productive. There is some evidence that workplace programs to improve diet and physical activity can be effective in helping employees control their weight and may also benefit PD06-03

11 employers by reducing absenteeism and drug insurance costs. 8 Increasingly employers are recognizing such benefits, for example by building on-site fitness facilities or entering into agreements with off-site fitness centres to provide programs for their employees; and providing showers, bike racks and other amenities for employees who want to make physical activity part of their daily work routine. We congratulate employers who have already taken such steps and encourage others to do the same. Communities Recommendation 9 The Canadian Medical Association calls on communities to create environments that encourage healthy and active living and on federal, provincial and territorial governments to support them in this endeavour. A healthy community encourages organized physical activity and creates environments and infrastructures that make it easy for its citizens to make physical activity part of their daily lives. Among the positive steps that communities can take in this direction are: developing and maintaining a community-wide network of walking and cycling paths; zoning communities in such a way that amenities are within walking distance of homes; increasing funding and improving access to sport and recreation facilities; and revising building codes to make stairs accessible, pleasant and safe, so that people have options to taking the elevator. Although these remedies are mainly the responsibility of municipal governments, federal, provincial and territorial governments can provide much-needed support, financial and otherwise, to help municipalities develop programs to meet their needs. Food industry To be successful, a national strategy to promote healthy weights requires the partnership and collaboration of food manufacturers. The CMA urges the food industry to become an active partner in such a strategy, by reducing the salt, sugar, saturated fat, trans fat and calorie content of pre-prepared meals; offering a variety of nutritious foods and portion sizes on restaurant menus and providing information about the calorie and nutrition content of restaurant foods; restricting advertising and in-store promotion of highsugar, high-fat foods, particularly those aimed at children; providing user-friendly consumer information about their products, including complete nutrition content and accurate advertising claims; and increasing the amount of information provided on product labels; for example, by including the percentage of calories as fat. Government policies that promote nutrition and physical activity Tobacco use in Canada declined when government policies, such as high taxes and smoke-free public places, discouraged people from smoking. Some experts believe government measures may also be the key to successful promotion of healthy weight and physical activity. Health Canada already undertakes a number of activities. In recent years, it has improved its product labeling requirements, providing Canadians with detailed information about the nutritional content of packaged foods. It has also distributed resource material and implemented public education programs to raise Canadians awareness of the importance of healthy eating and physical activity. Governments at all levels can build on these activities with new public policy initiatives. Recommendation 10 The Canadian Medical Association calls on governments to increase access by all Canadians to nutritious food at affordable prices. The price of milk, produce and other healthy foods varies greatly in different parts of Canada. In remote areas, they are often more expensive than manufactured, nutrition-poor foods because of high transportation costs. Even in urban areas, nutritious food may be unaffordable for people on low incomes. Governments could explore subsidizing transportation of produce to remote areas, implementing school meal programs, taking into account the cost of purchasing healthy food when setting social assistance rates and other means of ensuring that all Canadians have access to healthy foods at a reasonable price. Recommendation 11 The Canadian Medical Association calls on governments to PD06-03

12 explore ways to restrict the advertising and promotion of high-calorie, nutrient-poor foods. The typical Canadian child may be exposed to as many as 40,000 advertisements for food a year. 9 This does not include point-of-sale promotions, such as displays of candy bars at convenience-store counters. Although the effect of banning advertising as an obesity-control option has not been evaluated, the CMA thinks this method should be explored. In particular, the CMA recommends that media advertising of high-calorie, nutrient-poor junk food in children s television programs be banned altogether. Recommendation 12 The Canadian Medical Association calls on governments to set rigorous standards for food labeling and for the advertising of health claims for food. As we have already noted, Canada has greatly improved the content of its nutrition labels. However, much nutrition information available to Canadians, particularly if provided in advertisements or promotional material, may still be misleading. In general, the CMA believes that brand-specific advertising is a less than optimal way to provide health information to consumers, who should be encouraged to seek out objective information sources for answers to their questions about physical activity and healthy eating. To improve the quality of information Canadians receive through commercial channels, the CMA recommends that health claims made for foods be strictly regulated to ensure that they are based on the best available scientific evidence and that they are accurately communicated to consumers. Food advertisements should be pre-cleared before airing in the media, and the provisions against deceptive advertising in the Food and Drug Act should be strengthened. Recommendation 13 The Canadian Medical Association recommends that governments explore tax incentives as a component of a national strategy for healthy living. Some have advocated the idea of using the tax system to encourage participation in physical activity and choice of nutritious, low-calorie foods. The CMA believes that this concept should be explored further to assess whether it will actually have this effect. For example, governments could provide tax credits to recreational organizations to help them provide sports equipment or training, particularly for children in need. Fostering surveillance and research Recommendation 14 The Canadian Medical Association recommends that governments at all levels invest in evidence-based research on healthy eating and physical activity and share the results of this research with all Canadians. One of the frustrations facing decision-makers as they combat obesity and promote healthy weight and physical activity, is the lack of knowledge about what works and what does not. The CMA encourages all partners to support research and pilot projects that will improve our knowledge base. Canada needs to continue gathering statistics on Canadians weight and analyzing changes and their possible causes. There is also a need to invest in research, particularly on: best measures for assessing overweight and obesity; the effectiveness of weight management and treatment programs; and the effect of policy interventions on healthy eating and physical activity and on rates of obesity and obesity-related disease. All projects and policies should be carefully evaluated and the results gathered into a comprehensive body of knowledge. This knowledge should be shared with health professionals and the public, in objective and user-friendly formats. The role of physicians and the health sector Physicians and other health professionals have an important role to play in promoting physical activity and healthy weight. In most cases, physicians are the patient s first point of contact with the health care system; they often see patients at teachable moments when, because of an associated health condition such as diabetes, they are motivated to change unhealthy behaviours. Physicians can also provide advice on nutrition and physical activity to patients as part of routine physical examinations. To help them counsel their patients, physicians and other health professionals benefit from clear guidance about the most effective ways to lose weight and maintain weight loss. Guidelines based on the best current evidence are available and should be promoted widely among health professionals. For example, the BCMA, in partnership with the province s PD06-03

13 ministry of health, has developed protocols for management of overweight, obesity and physical inactivity in practice. Physicians can help patients achieve and maintain a healthy weight by: regularly measuring their patients weight, e.g., through BMI or waist-hip ratios and recording the results on patients charts; screening for weight problems and promoting good nutrition and physical activity as part of the routine check-up; determining the factors that influence individual patients weight and activity levels; assessing patients readiness to change and tailoring interventions and support to their current situation; building and maintaining networks with other care providers, such as health educators and nutritionists, and with recreation centres and other facilities in the community to ensure that patients are referred to the services most appropriate to their needs; and becoming health advocates in their communities, by supporting measures such as walking trails and physical education programs in schools. The CMA supports its provincial and territorial divisions as they seek adequate reimbursement for physicians who counsel patients on healthy weight and physical activity. Physicians and other health professionals can set an example for their patients by demonstrating a personal commitment to healthy eating and physical activity. Professional associations and health facilities should show similar leadership by providing healthy food choices and physical activity programs for their employees. Ideally, as mentioned before, a national strategy for healthy living should encourage research into the most effective interventions to promote physical activity and control weight. As knowledge develops, physicians and other health professionals should be kept updated and encouraged to incorporate the most effective interventions into their practices. The CMA supports significant expansion in the medical school curriculum in the area of prevention and treatment of overweight and obesity. The CMA encourages colleges of physicians and specialty medical associations to develop continuing medical education courses on issues related to maintaining healthy weight, and it encourages physicians to pursue these courses. In addition, the CMA supports the continued development and refinement of clinical practice tools to help providers counsel and treat patients effectively. Conclusion Promoting physical activity and healthy weights in Canada will be a challenge, as it involves overcoming many barriers that now exist. However, it is a challenge that the CMA believes should be urgently met, through a long-term, wellfunded national strategy incorporating both individual behaviour change and healthy public policy. Physicians and the CMA look forward to working with others in developing and implementing this strategy to promote physical activity and healthy weight for all Canadians. References 1. Tjepkema M. Adult obesity in Canada: measured height and weight. Ottawa: Statistics Canada; Available: /adults/aobesity.htm (accessed 19 May 2006). 2. Shields M. Overweight Canadian children and adolescents. Ottawa: Statistics Canada; Available: (accessed 19 May 2006). 3. Chan JM, Rimm EB, Colditz GA, Stampfer MJ, Willett WC. Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes Care 1994;17(9): Colditz GA, Willett WC, Rotnitzky A, Manson JE. Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med 1995;122(7): Type 2 diabetes increasing dramatically among kids. Toronto: CBC News, 12 May Available: /national/2005/05/11/obesity html (accessed 19 May 2006). 6. Food Statistics, vol. 4(2). Ottawa: Statistics Canada; Cat XIE. 7. Global strategy on diet, physical activity and health. Geneva: World Health Organization; Available: activity/strategy/eb11344/strategy_english_web.pdf (accessed 19 May 2006). 8. Canadian Population Health Initiative. Improving the health of Canadians: promoting healthy weights. Ottawa: Canadian Institute for Health Information; The role of media in childhood obesity. Menlo Park, CA: Kaiser Family Foundation; Feb Available: /entmedia022404pkg.cfm (accessed 19 May 2006). PD06-03