John Crown (Independent) | Oireachtas source

In my day job I am increasingly focused on dietary issues because quite a few patients in my practice who have had breast cancer treatment have survived and are coming back for follow-up visits. The one thing that has emerged in the oncology literature in recent years is that in addition to the other well-recognised health implications of obesity and overweight there is also an increased risk of cancer. Not only that; there is an increased risk of the return of cancer if one has had it. That makes it a real and practical issue. I spend time taking dietary histories. It has forced me to the conclusion that we all need to know: it is not all about good food versus bad food. It is sometimes too much of the good foods. In fact, frequently it is too much of the good foods. If one talks to an average middle-aged or elderly person who is obese, they are not eating crisps or cakes but they are having a great big feed of spuds every night with their dinner. They sometimes cannot understand why they are not losing weight. As well as the quality of food we must focus as well on the quantity.

There is a whole parcel of things related to education in the medical curriculum. One of the most powerful interventions for the treatment of smoking or weight gain is for a doctor to sit down with a patient and talk to him or her. That is powerful and carries a weight that many other interventions do not have. One must incentivise doctors for all the reasons Dr. Orsmond has told us about.

The most extraordinary example of muddled health economics is going on currently. It can take six years to get bariatric weight reduction surgery in this country. The aggregate waiting list to see someone in the obesity clinic and then the waiting list following the clinic for those recommended for surgery can be six to seven years. It is desperate. During that time, the cost of treating those people, many of whom will die, for diabetes and sleep apnoea, which is unbelievably expensive to treat, is high. It could be cost-neutral if we could shorten the waiting list and offer more people nutritional counselling.

Dr. Orsmond referred to the unhealthy lives of Irish doctors compared to those in Finland. There are approximately four times as many hospital specialists in Finland as in this country. She referred to a specialty. In oncology the figure is 6:1. We have a bizarrely understaffed medical structure in this country, which is not good for the health of doctors or their patients. It means there is no opportunity to sit down and have a ten-minute or 15-minute conversation with someone about his or her weight when the waiting list is full of another 120 who are waiting to come in to see one, who in turn might save the health service money if such a preventative intervention is made. There is a real need to examine the situation.

To give some perspective to the witnesses in terms of the committee's sincerity about public health measures, this is the same committee which two months ago voted not to make Leinster House a smoke-free campus.