Interventions in Committee
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Jonathan Will
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Jonathan Will
2015-03-24 11:06
Thank you, Madam Chair, and distinguished members of the committee.
I'm here with my colleague, Catherine Scott, to speak to you about women in skilled trades and STEM occupations. Over the past few decades, Canadian women have made considerable progress and are world leaders in both educational attainment and labour market performance.
Looking first to education, as of 2013, 56% of new post-secondary graduates were women, outnumbering men at the college, undergraduate, and master's levels. While women continue to trail men in graduation at the doctoral level, this gap is closing. Today women make up just under half of Canada's Ph.D. graduates. Canada is a world leader in female participation in education with the highest rate of post-secondary attainment among OECD countries for 25- to 64-year-old women in 2012.
Women have also made significant advances in the labour market. Over the past 30 years, the overall female employment rate has risen from 48% to 58%. Currently, women account for approximately 48% of all workers in Canada.
Internationally, Canadian women currently have the 5th highest labour force participation rate and the 7th highest employment rate in the OECD. While women have made significant advances, some areas of concern remain.
At the post-secondary level, women continue to be under-represented in the science, technology, engineering, and mathematics fields, commonly referred to as STEM. ln 2013 just over 30% of post-secondary students in STEM fields were women. Female under-representation is particularly acute in architecture, engineering and related technologies, and mathematics, computer, and information sciences. Women represent a slim majority in agriculture, natural resources and conservation, physical and life sciences, and technologies.
We also know that some young women are choosing not to pursue STEM fields of study—in other words, science, technology, engineering and math—despite outperforming their male counterparts in high school.
This situation has important economic implications for Canada. STEM skills are essential to productivity-enhancing innovation. If a significant portion of the population is not fully represented in the STEM talent pool, this could negatively affect Canada's ability to innovate and grow.
In addition, earnings in STEM occupations are typically higher than in non-STEM occupations.
ESDC projections show that the occupations expected to be in shortage over the next decade are more likely to have low rates of female participation than non-shortage occupations. Almost half of all occupations projected to be in shortage are male dominated, while only one-quarter are female dominated. The remaining quarter has a relatively equal mix of men and women. STEM and the skilled trades comprise 34% of the projected shortage occupations.
These findings clearly show that supporting employment in high-demand occupations and addressing the under-representation of women can be highly complementary priorities.
At ESDC, a number of recent measures have been taken to support employment in high-demand occupations, including STEM and the skilled trades.
A key means of addressing the under-representation of women is by supporting access to post-secondary education, a requirement for many occupations that represent non-traditional jobs for women.
The Canada student loans program provides financial assistance to post-secondary students with demonstrated financial need through the provision of loans and grants. Women make up 60% of the recipients.
ESDC is also helping young men and women to access post-secondary education through the support it provides to Pathways to Education, an organization with an established record of raising post-secondary enrolment among disadvantaged youth.
ln addition to supporting access to post-secondary education, ESDC has a number of other measures in place to help Canadians develop job-relevant skills and find employment, including in high-demand occupations such as STEM and the skilled trades. ESDC has taken action to directly support job relevant skills development with the introduction of the Canada job grant, which links training directly to employment.
Over $2 billion per year is provided to provinces and territories through the labour market development agreements to help unemployed Canadians quickly find and return to work, including support for women in apprenticeship training. The Government of Canada is committed to strengthening these agreements in consultation with provinces and territories to better align training with labour market demand.
ESDC has also taken steps to improve the quality of information for Canadians with respect to the labour market and apprenticeship.
The Job Bank and Working in Canada Web sites have been consolidated to offer Canadians a convenient single point of access for reliable information on job market trends, occupational profiles and job opportunities.
A new job alert system was launched in 2013 to provide Canadians with job market information up to twice daily.
Economic action plan 2014 invested $11.8 million over two years and $3.3 million per year on an ongoing basis to launch an enhanced job-matching service that is helping to ensure that Canadians are given the first chance at available jobs in their local area that match their skills.
ESDC is currently developing a web-based career tool to provide Canadians with better information about labour market outcomes by field of study. This will help to ensure that youth are able to make well-informed choices about learning and work. The main portal for learning information,, provides information and interactive tools to help Canadians pay, plan, and save for their post-secondary education.
ln addition to its suite of programs, ESDC has asked the Council of Canadian Academies to study how well Canada is prepared to meet future demand for STEM skills.
These are just some of the ways that my department is helping to ensure that women can reach their potential in Canada's learning institutions and labour market.
My colleague Catherine Scott will now speak to the importance of women's participation in the skilled trades and some of the department's relevant programs and support.
Janice McDonald
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Janice McDonald
2014-11-04 8:48
Thank you, Madam Chair and committee members, for the opportunity to speak to you today about economic leadership and prosperity for women in Canada.
My name is Janice McDonald and I am a serial entrepreneur in the music and apparel industry. I'm delighted to contribute to the important work you are doing in looking at systemic barriers to women's advancement. I've been interested in this topic for a long time as an entrepreneur, volunteer, and because of my own research.
I've been an entrepreneur in Canada for over two decades. There has been considerable change in the small business landscape over that time period.
When my partner and I opened up our first retail music store in 1991, we were open for business. We didn't start up; we opened up. There were not start-ups, just businesses growing and opening.
As young entrepreneurs we had few peers choose the same career path. Most of our friends and colleagues did not see entrepreneurship as an option. That has changed.
In 1991, formal mentorship programs were not available, or at least we were not aware of them. Now entrepreneurs can access innovation hubs, crowdsource funding, angel investors, and all kinds of support. Organizations like Futurpreneur did not exist.
Futurpreneur is a national non-profit organization dedicated to growing our economy one entrepreneur at a time. The focus on start-up culture has increased significantly. The shift has been gradual, but now support for entrepreneurs is everywhere.
My latest start-up is called This Space Works. It's like Airbnb for business. We are part of the sharing economy, and use excess capacity in physical spaces and make it available to mobile professionals and businesses who need it.
Although seasoned ourselves, we have gathered mentors to assist us to grow our start-up. MaRS Discovery District in Toronto, Communitech in Waterloo, the Innovation Factory in Hamilton, each of these organizations is helping our company grow.
In 1992, I completed my master's in Canadian studies. My thesis topic was “Women and the Appointment Process in Canada on Agencies, Boards, Councils, and Commissions”. That was before we considered women diversity. Women were under-represented, but it was viewed as a gender and power issue, not as a diversity issue. The numbers did not look good in 1992 and as we know, change has been slow.
My commitment to women's advancement has remained. I share my time and talents with numerous organizations focused on making a difference in this regard.
Comprised of leaders from the most senior levels of government, business, academia, and the non-profit sector, members of the Women's Leadership Board at Harvard's Kennedy School serve as key supporters and ambassadors to the women in public policy program.
I am a member of the Women's Leadership Board and am going to Harvard tomorrow for three days of meetings.
Board members ask, “What can we do to create gender equality and improve the lives of women and men around the world?” The focus is on rigorous, high-impact research to further the shared mission of closing gender gaps. The gender action portal is a vital resource.
I am chair of the Canadian Women in Communications and Technology national board. The goal is to advance women in Canada in communications and technology. The non-profit organization focuses on recognition, career advancement, and mentorship. It has been doing incredible work for women for over 20 years.
We believe our members can ignite their career with mentorship. In the latest issue of Women's Executive Network's The Opinion magazine, my article on mentorship talks about the value of it in career development. I have been a long-standing formal and informal mentor to women in business and the communications industry. I have seen first-hand the impact it can have on women's careers. A mentor can help you get to next faster.
Last year, I ran the mentorship program for WCT, and successfully matched over 20 women across Canada with senior women mentors. WCT believes mentorship is essential to career development. The WCT program is a gold standard.
The program has been running for 14 years. The call has just gone out to members to apply for the program. It is free to WCT members, and senior women mentors donate their time and share their talents for a one-year commitment. The program is made possible by the financial support of Shaw Media. It is a cornerstone to WCT programming.
The WCT commitment to mentorship is unwavering. We also know that sponsorship is vital as well. Visioned by WCT, the protegé project was created in conjunction with Catalyst Canada and supported by Shaw Media. This is a brand new pioneering project. The ripple effects of the program will be significant. It is a new collaborative venture whose promise is to level the playing field for women in the ICT sector in Canada.
We want to make sure rising stars in the industry make it to the C-suite. Over 10 senior executives in leading communications, media, and technology organizations have signed on to personally support the program. An equivalent number of female corporate executives will be selected and matched to work with sponsors to sharpen their leadership and business acumen.
We believe the ripple effects of the program will be significant. No one else has done a cross-industry sponsor-matching program for senior women. It will be a game changer. My personal commitment to mentorship is also unwavering. I've been invited to join the Cherie Blair Foundation for Women as a mentor. Their philosophy is to invest in women entrepreneurs so they can build their businesses. Women benefit from the program as their businesses grow, as do their families and communities.
The Cherie Blair Foundation believes if you empower women you drive growth. So do I. Their mentoring women in business program is successful. They have over 800 mentors and mentees enrolled in the program. It is offered across physical and cultural distances through the use of technology. I'm proud to offer my skills and talents to a woman somewhere in the world and help her grow her business. My match will be completed later this month and I will work with my mentee for one year.
I'm also the current chair of the Ottawa chapter of the International Women's Forum. I am passionate about this global organization for women. IWF advances women's leadership across careers, cultures, and continents. Members are committed to bettering global leadership today and cultivating women leaders of tomorrow. Fifty-five hundred women leaders around the world are IWF members. The organization began in 1982 in the U.S.A. and there are IWF members in six continents and 33 nations. In Canada, IWF has approximately 500 members in chapters across the country. The organization is very active and interested in women's leadership.
One area of focus for IWF Canada members is to increase the number of women on corporate boards. IWF Canada is interested in and committed to seeing more women join corporate boards. The IWF national board agreed to direct time and effort to create the tools for change for its members. The sole focus of the committee has been to gather all of the necessary information for its members to join those boards. Members can access an exceptional road map to assist them. The proprietary work covers the eco-system for women on boards, vital research, the business case and approaches used in other countries. Additional information includes sections on how to succeed, prepare for interviews, and get known. It is a strategic, comprehensive, and valuable tool for any IWF member. The women on boards initiative by IWF enables any of its members who are serious about joining a board to have the information and tools necessary to succeed. Several board members attribute their recent placement on a corporate board in part to the IWF information available to them.
Like many IWF members, I received my Institute of Corporate Directors designation from the directors education program. The program is offered nationally at Canada's top business schools. Since the launch of the directors education program, more than 3,000 directors have completed the program and over 1,900 have earned their ICD.D designation. The designation reflects a director's commitment to ongoing learning and development. The program is designed to help directors overcome the challenges they face in fulfilling their roles as directors. The training program is also a rich source of networking opportunities with classmates in the most senior roles in organizations across Canada. For that reason alone, more women need to participate.
Given the complexities of business today, we can expect more boards to seek out directors with governance training. If governance training and the ICD.D designation is valued by corporate boards, then hopefully more women will apply and be selected to receive this invaluable education. In my cohort, DEP-46, we did not have an equal number of men and women in the class. If governance training is a pipeline for future directors, we need to ensure that more women receive the training offered. The Institute for Corporate Directors offers scholarships to its directors education program and it would be ideal if more scholarships were available and offered specifically for women to access.
I believe we have many qualified and board-ready women across Canada. I don't think it is a pipeline issue and we know the business case is made for women on boards. Equipping more women with governance training is one more way we can eliminate barriers to women’s success on corporate boards.
Mentorship is a critical element for women’s success, as is sponsorship. Dedicated organizations, like IWF and WCT, are taking up the challenge. Although change is hard and slow, it is possible. We all win when women are empowered.
JudyLynn Archer
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JudyLynn Archer
2014-11-04 9:07
Thank you for the opportunity to join the conversation today.
I'm here today to talk about women in construction. As we all know, Canada needs all hands on deck to support the continued industrial investment that helps drive our economy. This means we must ensure that Canada has the workforce it needs to build, operate, maintain, and provide leadership on those big projects. The challenge is that this industry will lose 24% of its workforce and specifically those individuals who have moved up in the ranks and into leadership positions. We're going to lose those people to retirement and global competition.
Underemployed women in Canada comprise the largest underutilized workforce in Canada. These are jobs that require no student debt to get into or to succeed at. Canada needs to support any and all proven initiatives that attract and prepare those who want to enter this industry, in particular women.
Women coming out of the Women Building Futures programs on average see an increase in their annual income by 127% on day of hire. What's not working right now is the funding that's needed to help women get into this industry.
The recent Status of Women Canada call for proposals forces respondents to create projects that will repeat work that's already done. It called for research and the identification of best practices and gaps in service. It allows for no training, awareness, mentorship, or any direct service to women as part of the project. It is our opinion that there is a plethora of existing research out there that identifies gaps, success strategies, and best practices related to this specific issue. This funding could be applied directly to what Canada really needs in women, which is programs that will attract and prepare women for construction jobs, including those jobs that offer leadership opportunity at a high rate of pay, I might add.
This year alone, Women Building Futures has seen 5,000 women come through its doors looking for a way to come into this industry. Our funding allows us to train 120 of those 5,000 people. We have a 90% success rate in helping women get to work in this industry, increasing their average annual income by 127% on day of hire, and yet organizations like ours are ineligible for the funding from Status of Women Canada. It doesn’t make sense to us.
Our recommendation is that Status of Women Canada funding should support direct programming that does have a proven track record in helping women get to work in areas that will result in economic prosperity for those women.
Next, I'm going to speak momentarily on equality. Women, boys, men, and girls are not homogenous, yet government policies that drive programs are often based on all people being equal. This framework negatively impacts half the population of Canada. I'm going to give you a short case study to demonstrate this.
I'm going to talk about Susan. Susan's a single parent of two, works full-time earning $30,000 a year. She wants a career that will increase her income substantially and offer leadership opportunity. Construction is her industry of choice. Susan applies for a construction training program that has a proven track record of success. The program is fully funded by an employer. The trick is Susan doesn't have sufficient savings to cover her living costs during this eight-week training program, so she goes to the Government of Alberta to request a counsel to leave, which is a process to request permission to leave her current low-paying job so that she can have money to pay her bills and feed the kids while in this eight-week training program. The cost to government would be approximately $3,000, or 1% of the investment that that company is making in that individual. The response from government was no. Living costs for people in this type of training program are not an eligible expenditure.
Here's the rub: men are hired every day in Canada's construction industry without having to take any type of training. The reality is very different for women. Women must be much better than, in order to be seen as good as. That's just how it is. Opportunity in this industry is significant for women, but it is far from equitable. This woman will not be hired without the training. Barriers to training are reinforced by government policies that treat everyone as equal when they are not.
This case study is real. The woman was denied housing support and therefore was not able to enter the training program. She remains underemployed, unable to boost her tax contribution, and unable to boost her consumption of goods. Government will continue to subsidize her and her children, and industry has lost another potential local worker and future leader.
What we ask is that gender-based analysis be used when creating policies and programs across all ministries and all programs. We would also ask that governments collaborate with each other so that we can fill these cracks that are impacting women every day.
Those are the points I wanted to make today, and I thank you for the opportunity to make them.
View Stella Ambler Profile
Thank you to all three of our wonderful presenters today. We very much appreciate your coming to inform our study.
Ms. Archer, I want to thank you for your presentation and for bringing your unique perspective to us. In particular, the numbers that you gave us, the statistics, were enlightening and surprising. Your program sees a 127% increase in income on the first day of employment. That is very impressive, and it's a little bit sad that 5,000 women have come through your doors but that you can only help 120. Thank you for sharing that information with us.
Can you tell us what your program does exactly? How do you achieve that kind of success, the increase in income from day one? Why do women need training but men do not to get into the construction industry?
JudyLynn Archer
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JudyLynn Archer
2014-11-04 9:45
First, with regard to the increase in income, for women who are coming into our programs and heading into an apprenticeship, into a trade, the average increase is 127% on day of hire. For women who are coming into our programs and going into some of the other areas of construction, such as heavy equipment operating, that average income increase is 169% on day of hire. Just to make sure, I've differentiated between those two: the increase is significant no matter what she goes into.
If you take a look at the average income of a woman working full time in Canada, it's approximately $32,000 a year. When you compare that with a person working in the construction industry, it would be triple that, at minimum. This industry provides incredible opportunity. It comes with no student debt, a way to earn as you learn, and a way to make an income that most women would not dream about.
Why do women need training and men don't? I can't remember the young woman's name, but she said it best: it's just the way it is. This is a predominantly male industry, 96% men. It has just been the natural way of things, the natural order of life, that men have walked into these jobs. They walk into these jobs every single day and are hired. The standards to which they are held are much lower than the standards to which women are held. Women definitely must be much better than to be seen as good as.
In terms of our success, our success rate is 90% or greater, consistently, with women coming into our programs. That's because we understand the challenges that women face in this industry. We seek out women who have tenacity. They need to have smarts and all of that, but they need to have tenacity, perseverance, and the objective to succeed. We select carefully the women we're going to train.
Let me just tell you that if we train a woman and she ends up over in one of the big companies, if she doesn't work out, then that company will not come back to our organization and hire another woman. That's the reality.
JudyLynn Archer
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JudyLynn Archer
2014-11-04 9:48
The first step in the program consists of awareness, helping women understand what these opportunities are and what realities come along with these opportunities. This is not for every man or woman.
The second step is to help women make a well-informed decision before coming into this industry.
Third, we provide hands-on skills training: welding, electrical, pipe-fitting, whatever. We provide the hands-on skills training, but most importantly, we provide workplace culture awareness training that helps women understand the industry, the predominantly male environment, and how to thrive within that environment.
Last, we do job matching. We help every woman who comes through our program find a job that will be successful for her and the company. We provide ongoing coaching to ensure that each woman who goes into an apprenticeship actually becomes a registered apprentice and successfully completes her first year of technical training in the shortest allowable timeframe.
Those are the key—
Carly Lambert-Crawford
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Carly Lambert-Crawford
2014-03-05 15:31
Thank you for having me here today.
I am a psychotherapist treating anxiety, depression, and eating disorders in Burlington, Ontario. I am also a proud member of the steering committee of the National Initiative for Eating Disorders.
I am here representing the voice of my clients along with my own voice as a survivor of anorexia. I'm proud to say that I'm one of the people that were able to get through our system despite its flaws.
As a therapist I often see people who the system didn't work for, the people who are waiting. I treat the most desperate of individuals and the sickest of the sick. They are lonely and desperate. I have only been a therapist for five years, and in my early career I have seen one of my clients die from anorexia. That is one client too many. She was bounced around, kicked out, and misunderstood. She struggled with OCD in addition to her eating disorder, and this left her paralyzed with fear. She was 20 years old when she died.
I have since known three more women who I was in treatment with who have all died from complications of their eating disorder. They were all under the age of 30 and were part of our system of care.
I can tell you right now that the statistics on eating disorders are downplaying this issue a thousand times over and millions are suffering in silence.
Prior to my work as a private practitioner, I worked as the program director at Danielle's Place, an eating disorder and support resource centre in Burlington, similar to Sheena's Place. Throughout my three years directing the centre, we had a terrible time getting funding to keep our doors open. Our aim was to provide services that were free of charge and would be free of waiting lists and were able to support the hundreds of men and women each year. Unfortunately, when I left the centre, they had to close their doors. This was devastating for a number of clients who saw the centre as their regular safe haven.
The inability to recognize the severity of the illness is one of the diagnostic criteria for anorexia nervosa, and this was me. I was one of the ones who had no idea that this was happening to me. Before I was diagnosed with anorexia, I was diagnosed with severe depression and anxiety. I suffered so badly that I really and truly did not know how to live without being on a myriad of different drugs to calm me down.
My eating disorder probably started when I was 16 years old. It was at this time that my family had gone through an extremely traumatic event, which is very typical for the onset of mental illness. Anorexia was one of the greatest gifts because it numbed my brain and it really helped slow these thoughts down.
Things went downhill pretty quickly, as they do, and all of a sudden things were getting harder for me to do. My doctor told me that I was underweight because I was a competitive athlete. He put me on a myriad of antidepressants that left me feeling a confused mess. I never weighed myself. This also surprises people. When I first weighed myself, it was the first thing that scared me enough to go to a specialist for assessment.
The next couple of years of my life are the hardest for me to talk about. These were the years that I was battling the system and myself. I had no idea what was happening to me. My world was falling apart. I was defeated. After years of loving the anorexia I let it take me.
From here I have a hard time remembering why, but I ended up on a psych ward in another city. I was the only anorexic patient within their whole entire program. My illness took over at this point and I was asked to leave that program. I was hospitalized in the ICU at my local hospital. I have had many doctors tell me they don't know how I survived.
I'm telling you this not to make you feel sorry for me, but for you to understand that my story is not unique. This happened all while I was waiting for an assessment with a local treatment centre. This happened while my parents were begging for someone to talk to me and for someone to understand. This all happened because I was kicked out of the psych ward because they did not know how to help me and my weight kept dropping. They asked me to leave their program at ... pounds at 20 years of age. [Pursuant to a motion passed on April 30, 2014, a portion of this testimony has been deleted. See Minutes of Proceedings] They discharged me from hospital at that weight because they told me I was being non-compliant.
From that moment on, I had no will to live or fight. My weight went down significantly and I ended up in the ICU surrounded by individuals who were three, four, or five times my age and dying of heart failure, cancer and other terminal illnesses.
My name happened to come up for an assessment at the Toronto General eating disorders program after waiting for four months for the assessment. They would not let me do the assessment over the phone and did not have the resources to send their specialist to me while I was in the hospital so I had to go by ambulance from Burlington to Toronto, hooked up to IVs, a tube that was feeding me and a heart monitor making sure I didn't go into cardiac arrest, just to prove that I was sick enough for their program. I actually remember lying there in bed completely out of it while a team of doctors asked me questions.
Does this seem right?
There is something wrong with our system. Would they make a child who was sick with cancer travel that long distance to prove they needed radiation or chemotherapy or to prove they needed to see an oncologist? From here I was put on a waiting list. I waited for four more months in a hospital where I endured the most disgusting abuse from the staff, which gave me the courage and the passion to do what I do today.
I don't want anyone to have to be told that there are a lot of other people there who are sicker than them and to just eat and stop taking up a bed, or to be told that they are too sick to talk to anyone and to not be given a voice to even try to understand.
I was eventually able to get a bed at the Toronto General eating disorders program. I spent four months there and left prematurely. I relapsed immediately, and from there I was facing outpatient treatments and very expensive individual therapy.
I worked tirelessly with my family and my husband to get where I am today. Many things that happened in my life were very influential in my recovery. Those seven years were the hardest of my life as I battled that system, but I truly believe my eating disorder has made me a better person. However, I will never ever underestimate the power this has on any individual that is diagnosed.
What I am here to get across today is that eating disorders are truly deadly illnesses. They take your life away and destroy families. As is the case with many other mental illnesses, people just do not understand. They feel an eating disorder is something you can just fix, something you need to address and get over. What we know now is that this is an illness of the brain, a psychological illness that takes away all logic and reasoning. I cannot believe how lucky I am to be sitting here right now, and how close my life came to ending. I have a very hard time making sense of it. I have a hard time making sense of it because there is no sense to make.
People die from this illness because there aren't adequate resources to treat it. Doctors misdiagnose and minimize the struggles, and people end up feeling enabled and blamed for something they do not understand. The prognosis for eating disorders is not very good. We know that it is hard to recover, and the longer the eating disorder goes on, the lower the chances for a full recovery.
We need help to make sure that when people are ready, there is treatment available. We need to put eating disorders on the radar and help people correct their misinterpretations of this illness and erase the stigma.
There are three aspects that I feel are most important to focus on at this time.
First is funding. As others who have spoken at this forum have said, I believe there needs to be equitable funding for eating disorders and other related illnesses. There need to be more beds and spots available so that waiting lists are shortened.
Second, I believe there needs to be an equitable amount of OHIP coverage for youth and adults who are struggling with eating disorders. OHIP is quite easily convinced to send anyone under the age of 18 to programs in the United States for specialized and timely care; however, anyone older is told to make use of our resources here.
Third, I believe there needs to be mandatory training for medical professionals to be able to properly screen and diagnose eating disorders. There needs to be more awareness and consistency among general practitioners, nurses, psychiatrists, and other professionals to ensure that this illness doesn't continue to be swept aside.
At this time, I am happy to answer any questions to help you understand my perspective and to offer any insight I may be able to bring to the study.
Thank you.
Elaine Stevenson
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Elaine Stevenson
2014-03-03 16:05
Madam Chair and committee members, thank you for the opportunity to present to you on eating disorders. I feel fortunate to have worked in partnership with many of the people who have previously presented to this committee on Canadian eating disorder services advocacy.
I would like to share with you my personal observations on the harmful effects that eating disorders can have on your child, your entire family, and society in general.
I will provide a list of recommendations concerning a number of urgently needed eating disorder services. This list has been formed over the 24 years that I have been involved as an advocate for those suffering from eating disorders. I have had the privilege of meeting many family members and their children suffering from eating disorders from across Canada. I have met many of them at conferences where I have spoken, provincially, nationally, and internationally, and at community forums for clinicians, and I have often lectured to fourth-year mental health nurses.
Eating disorders are cloaked in the three S's: shame, secrecy, and silence. This condition is made worse by its debilitating, deteriorating, and potentially deadly effect on those who suffer. Eating disorders affect those from many cultures and socio-economic backgrounds. I am alarmed, but sadly not surprised, by the intensive research results here in Canada by Dr. Leora Pinhas that indicate that children as young as five years of age are developing eating disorders.
Anorexia has the highest mortality rate of any psychiatric illness. It is estimated that 10% of the individuals with anorexia will die within 10 years of the onset of the eating disorder.
On August 27—I have a picture of our daughter Alyssa—our family's lives changed forever. Our daughter Alyssa passed away at 24 years of age after a 12-year battle with her eating disorder. Alyssa's eating disorder and her death continue today to have serious consequences for our family. Countless other families all across Canada also continue to feel the effects of losing a family member to an eating disorder.
I am very saddened that today, after 24 years as an advocate, we still have many families desperately searching for timely, specialized eating disorder programming for their children. Long waiting lists exist from as much as six months to a year and a half for many who suffer. As you have already heard from Dr. Woodside, early specialized eating disorder treatment intervention, as with many other illnesses, is often one of the most important keys to a successful recovery.
The situation is often worse for many who live in rural and northern communities. Mental health workers in these areas service several communities spread out over a wide area and often do not have expertise in treating eating disorders. Critical eating disorder services are often only offered in large urban cities. It is extremely difficult for many to leave their homes and family for intensive eating disorder treatment in a city where they know nobody and often feel isolated and depressed. Parents often can't leave their jobs to provide emotional support during their child's treatment. Some clients leave treatment early due to loneliness and isolation from their families.
Many times families know instinctively that their child is in extreme physical, mental, and emotional danger. Their child can't wait for treatment, and they will search frantically for specialized private eating disorder therapists or programs, or will send their child out of province and even out of country for treatment. Many parents also have to pick up living expenses for their children, as many who suffer from eating disorders are unable to work.
As parents, we had no choice but to seek private therapy for Alyssa. At $120 an hour—now this is back in the 1990s; it's up to about $150 or $160 now—three times a week for three-hour sessions for almost 12 years, therapy financially impacted our whole family.
I am outraged that the issue of long waiting lists for urgently needed eating disorder treatment still occurs across our country. To me, there is something inherently wrong with a public health care system that often only becomes available when someone is on death's door.
We would never think of making patients suffering from cancer, diabetes, or heart disease wait that long for urgent treatment. Yet, eating disorders can be just as deadly, as many suffer continually from electrolyte imbalances that can lead to cardiac arrest, kidney failure, and even death. We're talking about saving people's lives here, improving their quality of life, and helping them to begin treatment to feel well again.
Under Canada's Health Act, two of the five principles, universality and accessibility, indicate that all insured residents are entitled to the same level of health care and all insured persons have reasonable access to health care facilities. These principles do not exist for many suffering from eating disorders all across Canada.
In addition, many eating disorder clients also have co-occurring illnesses, such as obsessive compulsive disorder, anxiety disorder, severe depression, early onset of osteoporosis, severe dental problems, and drug addiction. They often engage in self-harm, such as burning, cutting, and even attempting or succeeding at suicide.
In the case of drug addiction, sometimes as parents we feel caught in the middle as many service providers will not take your child into treatment until the drug addiction or eating disorder is cured first. Both are dangerous health issues and I feel strongly that more programs need to be created that can treat concurrent illnesses at the same time.
As a society we also need to take a critical look at negative media messaging, often fuelled by the very powerful multi-billion dollar diet industry that consistently bombards us with the promise that being thin will bring you great health, happiness, sexiness, and acceptance by society. The pursuit of perfection and unachievable societal standards of beauty are causing irreparable physical, mental, emotional, spiritual damage, and even death.
As a parent and advocate I am often troubled by the fact that many doctors do not know or do not have much training in the treatment of eating disorders. I ask myself, “Why are many doctors often assessing only a person's body mass index to determine their overall health and whether there is a presence of an eating disorder?” Especially when the World Health Organization, in 1946, defined health as a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.
Consistent with this definition, interventions aimed at addressing any health concerns should be constructed from a holistic perspective, where equal consideration is given to social, mental, emotional, and physical aspects of health. To me one of the most serious omissions is that, provincially and federally, governments across our country are not tracking the incidence with which this deadly illness occurs. Experts that have already testified before you estimate that over a half a million Canadians suffer from eating disorders.
I believe that death statistics from eating disorders are not properly recorded. Often, the cause of death is listed as cardiac or kidney failure, and the contributing cause of death is listed as bulimia, anorexia, or often it's not even filled out. I know without a doubt that Alyssa's 12-year battle with an eating disorder was the cause of her death and the contributing cause to her death was cardiac pulmonary embolism, brought on directly by her eating disorder.
Dr. Blake Woodside testified that:
About 60% of my patients have chronic complex post-traumatic stress disorder. They've been sexually or physically abused. They will work for eight or ten years to recover from that...
Our daughter was sexually abused on several occasions and it wasn't until after her death that we as parents were able to find out the specific details of what had happened to her as she had declared the sexual abuse as an adult to her doctor and therapist. I feel strongly that, had we known the specific details, we may have had an opportunity to have brought closure to Alyssa on what happened and had an opportunity to support her in any criminal charges should she wished to have laid them, and maybe, yes maybe, even had a chance to save her life.
I believed with everything in my heart that we could have saved Alyssa from what she referred to as the monster within. But we were wrong. We can't bring Alyssa and all the others back who have died from eating disorders in Canada and indeed around the world.
The establishment of your status of women committee on eating disorders has given me so much hope that we can work together in partnership to save lives from this horrible and lethal illness. While there has been progress in eating disorder treatment over my 24 years as an advocate, it has been at a very slow and painful pace for those who suffer and their families.
Now I know I don’t have time to read all my recommendations—and I hope those have been forwarded to the committee already—but there’s one I must read: emergency and ICU training. We must ensure intensive training is required for clinicians who treat gravely ill eating disorder clients. They must have ongoing training to keep up to date on best practices and changes in treatment delivery. I believe, from our daughter's experience, that it is critical that all ICU staff be educated about re-nourishment and re-feeding syndrome and the essential need to re-nourish clients very, very slowly and monitor very closely to avoid electrolyte imbalances, seizures, cardiac arrhythmia, and even death.
In addition, we must look at different therapies to provide treatment for those who have suffered from post-traumatic stress disorder and abuse—verbal, physical, emotional, and sexual.
Laura Beattie
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Laura Beattie
2014-03-03 17:18
Yes. I think it's gotten better in four years, but our primary care providers need a lot more education, continuing education. Our medical students, residents, they're not trained. All they hear about is the obesity epidemic. I did prepare a brief. I've got growth charts in there as well to show you. But, yes, I had to find it online. I suspected. Parents go through huge denial, but I knew how serious the illness was. A lot of times doctors, especially primary care providers, if they don't know what to do, they don't do anything. They can't do anything. We need to educate them and we need to give them the education, the tools, to know what to do.
We need standards all over Canada. It depends where you live, it really does. Even in Ontario, it depends. I'm very fortunate that I live in a city that has this. There are some places that don't have it. I know our treatments have improved. Even from when I started, the FBT has changed.
Arthur Boese
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Arthur Boese
2014-02-26 15:35
Thank you for allowing me to put on this presentation. I have two daughters who suffered from eating disorders. When I realized the severity of this disorder, I felt that I had to get involved to help these patients get good care in a timely fashion.
With that in mind, I approached Dr. Paul Garfinkel of CAMH, who was one of the leading authorities in eating disorders in North America back in the early 1980s. Dr. Garfinkel was the president and CEO for the Centre of Addiction and Mental Health. After several meetings he expressed an interest in possibly partnering with my company, Avalon Centers Inc. However, he found that he could do nothing until there was a change in the OHIP policy. With that in mind, I decided to open a pioneering facility, Avalon Centers Inc. Eating Disorder Treatment Center, in the U.S. in hopes of bringing that experience to Canada to help our patients here when the time was right. This was a multidisciplinary approach to the treatment of eating disorders. We had a not-for-profit company called Avalon R and D and a for-profit one called Avalon Centers Inc.
To build a cutting-edge partial hospitalization program, our well-educated clinical team of psychiatrists, psychologists, social workers, nurse practitioners, nurses, and art and yoga therapists needed to build the most up-to-date protocol available. In order to formulate this, we extracted the necessary information from Dr. Garfinkel's vast research. Because of all of the clinicians involved, it was a very expensive process.
After this protocol was completed, I contacted Homewood in Guelph and talked to Dr. Eduardo Perez and April Gates. Over the next few months we had many friendly and informative meetings. When they issued a contract to partner with Avalon, we gave them our confidential protocol. After keeping it for at least four months, they then decided not to go ahead.
We attended many eating disorder meetings and were a member of the Eating Disorders Association of Canada, whose president was Dr. Robbie Campbell. At one such function in Toronto, Dr. Blake Woodside told us that there were probably 100,000 eating disorder patients in Ontario and that 18% of them died. The main treatment available was Homewood in Guelph, which at times had as much as a two-year waiting list.
OHIP did agree to send us patients now and then, depending on who was in charge, but if someone, like MPP Peter Kormos for instance, called, they pushed the patient through the system.
Bellwood, in Toronto, was also very supportive and did occasionally send us a patient.
Once in the U.S. we required a state licence from the Office of Mental Health. We are proud to say we were the first to get a licence as a free-standing facility. This was four and a half years before anyone got a licence in the state of New York. It was quite a feat for us. We established ourselves in three buildings, serving partial hospitalization, outpatient, and a two-shift fully supervised group home, with approximately 30 employees in total in under 4,000 square feet of space. We treated anorexia nervosa, bulimia nervosa, and some obese patients.
In time we worked with Kevin Flynn, who obtained a budget to get OHIP to do an audit on our largest treatment centres in the U.S., ourselves included at the Avalon Centers Inc. Buffalo location. Their audit showed we were as good as the finest centres and better than most in the U.S. and only two hours away from Toronto, but still OHIP was unable to provide us with patients.
We had many meetings with 20 senators and assemblymen to obtain their support in the U.S. I worked closely with Senator Joseph Bruno, majority leader, and Senator George Maziarz of Lockport. They promised us a new 20,000-square-foot centre ready to proceed. We even had fully comprehensive drawings and land picked out. Unfortunately, funds became scarce because of the economic downturn in the U.S.
Since this is a mental disease, and wanting to help patients with their insurance coverage, we went to Washington to help obtain mental health parity with the HMOs. In Washington I ran into a colleague, Kitty Weston, from Minnesota. I told her that I had contacted Senator Hillary Clinton’s office and that she was going to come out to Avalon. But then 9/11 occurred. As it happened, Hillary Clinton was in Washington. My wife and I were fortunate enough to obtain a meeting with her, and she gave us her full support.
We also had an agreement with Dr. Thomas Rosenthal, professor, and chair of the department of family medicine, Buffalo, New York, that all graduating doctors in western New York would be trained by our clinicians in eating disorders, because this is not part of their training.
Through my dedication and personal finances only, we are happy to say we were able to save approximately 1,000 lives in the 11 years that our multidisciplinary partial hospitalization treatment program lasted. Our experience there has shown that the young patients are more receptive to a free-standing facility rather than hospital settings.
Because of my experience, I would be pleased to assist in the process of setting up similar facilities in Canada.
This is respectfully submitted.
Josée Champagne
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Josée Champagne
2014-02-26 15:42
I would like to begin by thanking you for having me today, as well. It's truly an honour for me to be here. I also want to thank you for conducting a study on eating disorders. This is a very important issue.
For 14 years, I have been the Executive Director of an organization called Anorexia and bulimia Quebec, or ANEB. This is a not-for-profit organization that provides services to individuals with an eating disorder and their families, across Quebec.
Our organization guarantees free, ad hoc and specialized assistance to individuals suffering from eating disorders, and to their loved ones. We provide a help and referral phone line, prevention activities and professional training. Over the past 14 years, I have seen time and time again how important community resources like ANEB are in the continuum of supportive services for individuals suffering from eating disorders.
Eating disorders are very worrisome public health problems in terms of their rising prevalence, but also in terms of their various manifestations, which are largely unknown and often go unnoticed. Those include anorexia, binge-eating disorder and muscle dysmorphia.
These eating disorders, as you have probably heard from many witnesses who came before me, have numerous psychological and physiological repercussions on the person suffering from them. If left untreated, the disorders may result in death. Unfortunately, these types of situations have occurred in recent years.
Despite this extremely alarming state of affairs, there are very few resources specializing in eating disorders in Quebec. The limited resources that do exist are in the public domain. The number of hospital beds available for individuals with eating disorders is very low—about 10 to 12 beds throughout Quebec.
For adults, it takes a very long time to obtain specialized third-line services for eating disorders. People can wait for months, even a year or sometimes longer, depending on the seriousness of their eating disorders. For people in distress, a few days is a long time. You can imagine what a few months, even a year, can be like. The resources available to people suffering from this disease are clearly insufficient.
Faced with those kinds of wait times, some people decide to turn to private resources for specialized assistance. However, those resources can also have considerably long waiting lists and charge a lot of money for their services. So that is not an option for most people suffering from eating disorders.
When it comes to treatment for eating disorders in Quebec, it may sometimes seem that we have a two-tier health care system. We have the private and the public systems. Currently, in Quebec, a number of public resource professionals are trying to compensate for that shortage in order to meet the demand. However, the sad reality is that few professionals know enough about those disorders to be able to respond effectively.
There is another major issue that should be pointed out. Most of the care available is concentrated in large urban centres. People living in the regions have few resources, and often feel isolated and misunderstood. They also feel like that they are the only ones with these kinds of problems.
We know that the number of individuals with an eating disorder will increase—and they will be younger and younger—and that the physical and psychological consequences are serious. There is an increasingly urgent need for action.
All my years with ANEB have made me see that much of the stigma around the illness has persisted. People still often say that all someone has to do is eat, that their disorder is just a whim, that eating disorders affect only girls, that an individual is not anorexic because they are not thin enough, and I could go on.
This lack of understanding of the disease and the misconceptions about it are sometimes even found among health care professionals who are not trained or informed regarding this issue. Patients are sent home if they are not thin enough because, according to the health care personnel, they are not exhibiting clear physical signs associated with undernutrition. Believe it or not, we are still seeing this in 2014.
In addition to the many persisting prejudices, the illness is still taboo, even in 2014. Those people are ashamed to seek help. They are afraid of being judged. The disease is more taboo among men.
What about loved ones and friends? Family members of affected individuals are often resourceless and powerless in the face of the disease. They feel that they lack information about the illness and about the treatment, and that they have little support in their suffering. They do not feel equipped to help their loved one.
Last year, over 750 family members of individuals with an eating disorder called the ANEB phone help line to seek assistance, and over 300 individuals turned to support groups for accurate information.
Following this reflection, we have a few recommendations for the committee.
It would be important to improve accessibility to specialized support services in the community in order to ensure appropriate and quick assistance for individuals waiting for support, but also after treatment.
It would also be important to consolidate the funding of organizations working with this clientele, so that energy can be invested into developing assistance, instead of into looking for funding. That's often what community organizations have to focus on.
In addition, it would be important to increase the number of awareness and information campaigns targeting the illness. More interest in this issue would go a long way in helping reduce the discrimination and stigma people with an eating disorder experience. It would also be a good idea to find known public figures who have suffered from an eating disorder and who would agree to talk about their experience with the disease.
It would be essential to make training programs more accessible to various professionals, so that they could identify eating disorders more quickly and effectively. That training should target far more professionals, as many of them are likely to deal with such cases. I am not talking about only health care professionals, but also professionals working in schools and sports coaches. That number should be increased as much as possible.
It would also be important to provide professionals with more tools, so that they can respond more effectively and appropriately to clients. This would really help reduce waiting lists for third-line services and provide services in the community.
The use of prevention programs in school should be more prevalent. Those programs would be based on research evidence. In addition, peer helpers should be trained to identify young people in schools.
That concludes my presentation. I hope this information will help you in your study on eating disorders among girls and women.
Thank you for listening.
Bonnie Brayton
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Bonnie Brayton
2014-02-26 16:04
Thank you again for allowing me to get back and get my document correctly printed.
I will say that my president took quite a bit of time to review the previous testimonies and certainly that impacted the way that we chose to prepare for today.
As we already heard from NEDIC, the actual face of an eating disorder is heterogeneous: mostly female, but also male; individuals who identify with their assigned sex and gender, and those who don't; racialized individuals; newcomers to Canada and established Canadians; individuals with physical disabilities; individuals with concurrent medical or psychological disorders, such as, diabetes, substance abuse, depression, PTSD, and so on. Individuals from all socio-economic walks of life have eating disorders.
From a feminist lens, we have long been concerned with the messages women and girls receive about body image, sexuality, and in particular, the sexualization of young girls in the media. Conversely, from a feminist-disability perspective, in the quest to present women as strong and capable, the larger movement does not always reflect the face of women and girls with disabilities. We look everywhere but do not see our faces, and often there is no place for us, no model to follow.
In the intervening time we also see the deadly and devastating impacts of Internet pornography and cyberbullying. Women and girls are being exposed to online sexual harassment and stalking. Sex is a commodity, and your stock rises and falls with your appearance.
No exploration of media and eating disorders would be complete without flagging the issues posed by online groups that are involved in trading ideas about how to binge and purge, further reinforcing deadly practices. Additional impacts also come in the media for our virtual invisibility and the way society views mental illness and invisible disabilities, refining our view to the context of disability.
People with mental disabilities tend to come at the bottom of the hierarchy of impairments, below those with physical and learning disabilities, because they are constructed as deviant and possessing a spoiled identity and lacking rationality....
I'm quoting from Beresford.
The media plays a fundamental role in this portrayal focusing on the strange or aggressive behaviour of people categorised as 'mentally ill'. This has real consequences for individuals living with such disabilities because politicians are affected by what is reported and shape policies around mental health accordingly.
Disabled women experience violence and have a unique risk as a result of this.
Many of us recount our experiences, as young children, of having to display our bodies to groups of male doctors in the guise of “medical treatment” without prior knowledge or consent. We may have been asked to strip, to walk back and forth in front of complete strangers so that they could get a better view of what the physical “problem” is, or to manually manipulate our limbs to determine flexibility and dexterity. Today, pictures or videos are taken of us and used as educational tools for future doctors, with little thought given to our needs to have control over what happens to our bodies or who sees us. While the medical profession attempts to maintain control over our bodies, some women with disabilities may attempt to regain control through dieting, bingeing or other methods of body mutilation.It is ableism at play when a doctor asks a woman with a disability to lose weight before she becomes too heavy for her caregivers to lift. And that ableism persists when a woman with a physical disability loses weight, and instead of asking how she did it, congratulates her on her “success.”
Though identified as a serious environmental risk factor for eating disorders, every psychiatrist who testified spoke about the active discrimination faced by women and girls with eating disorders. This discrimination is in clear contradiction to the spirit of the Convention on the Rights of Persons with Disabilities, insofar as the right to be assisted in the recovery from injuries posed by their abuse.
DAWN Canada supports the recommendations made by the medical professionals presenting here and those of NEDIC. We offer a discussion of our own.
Recommendation number one. Canada’s approach to eating disorders must be strategic and involve all levels of education, practice, and research. We need to ensure that the intersectional, gender, and disability lenses are also trained on the process of research, practice, education, public awareness, and disability inclusion. Public health measures aimed at prevention and early detection must include physician screening; public health nurse screening; school nurse, mental health, and addiction screening; as well as the intervention and recognition that violence against women and girls is a cause, effect, and risk factor for eating disorders. Women and girls need choice and a continuum of referral points.
Caution is also urged in the area of interventions such as neuro-stimulation and magnetic stimulation. There is promise, but have all the risks been taken into account?
Recommendation number two. There are many references to best practices and evidence-based care but there must be room for innovation, new ideas, and also creative care for women and girls with disabilities for whom current evidence-based interventions are not working.
Recommendation number three. We must ensure that women and girls with disabilities are included in discussions of eating disorders and body image. Our voices, perspectives, and indeed our images are necessary in order to move forward effectively.
Recommendation number four. Treatment programs must include women and girls with disabilities and take into account the intersection of gender, violence, and disability.
The services need to be competent in addressing eating disorders, trauma, addictions, and the medical effects of eating disorders and disabilities of women and girls who present for treatment rather than using intersecting disorders as a rationale for exclusion.
Facilities must be developed using the principles of universal access and information must be made available in alternate formats to ensure that all women have the information they need. Treatment must be holistic, multidisciplinary, and offer a range of choices along a continuum of peer support, community treatment, day programs, brief intervention, and long-term treatment. The interventions must take the developmental level of the woman or girl with a disability into account and be appropriately tailored for their needs.
There's a lot of discussion in the presentation about the concurrent addiction but not much discussion on the appropriateness of addiction treatment modalities in helping manage compulsive aspects of eating disorders. More research is needed to help see if addictions modalities could assist eating disorder treatment.
Remove barriers to mothers with disabilities and eating disorders who need to go to treatment. I give Alberta as an example where, under the Child, Youth and Family Enhancement Act, if a child is in care for 200 cumulative days, they move to make the child a permanent guardianship order. If a mother has no other place to care for her children than in temporary foster care, this is a discriminatory measure. We are not sure if this measure is similar in other provinces. In order to provide a structure and framework for therapy, access for determinant of health must be in place.
Justice also has a role to play with mental health diversion and the Elizabeth Fry Society, when people are arrested for stealing to finance binge cycles, as well as ensuring that adequate treatment opportunities exist for women and girls with disabilities.
Women and girls with disabilities must have positive media coverage. Women and girls with disabilities must have access to programming in which they can see their own lives and realities reflected in the Canadian discourse. The CRTC needs to be more active in promoting these measures.
Ever mindful of the slippery slope of assisted suicide—and I bring this forward because it's such an important issue in the Canadian discourse today and such an important issue to people with disabilities—we look at the risk for women with disabilities being valued less for scarce treatment resources because the younger person was perhaps seen as more viable. So she, as a 53-year-old woman, was left for nature to take its course. That's referring to Dr. Woodside's testimony of November 28, 2013.
In countries where euthanasia exists.... The case of Ann G, a 44-year-old woman with anorexia nervosa who died by euthanasia is one in a series of cases that have come out of Belgium, including recent cases, again, as a sidebar, that include the euthanizing of baby girls with spina bifida.
The human family in Canada simply must offer better to all of its citizens, including women and girls with disabilities.
I'm looking forward to preparing a written brief. We had less than a week's notice, so we were not able to prepare it for today, but I wanted to indicate that we would be recommending that the committee also hear from a young woman named Kaley Roosen, who's currently pursuing her Ph.D. at York University. Ms. Roosen's thesis and research is focused on eating disorders and women with physical disabilities. In addition, we will bring some important findings from her research in our written brief.
Thank you.
View Kirsty Duncan Profile
Lib. (ON)
Is part of this training for physicians to recognize and to screen for eating disorders? Should that be a recommendation?
Joanna Anderson
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Joanna Anderson
2014-02-12 16:23
Yes. Absolutely.
Ms. Martin noted earlier about children's growth curves. The first thing that we would always do when we got a child into the program was look at the way they had been growing normally until they had this intervention of an eating disorder. The idea is to get kids back on track of their own growth curve, not on some predetermined weight or shape that they want to be, or that they've decided would be best for them.
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