Ms Emma Ball:

As Dr. Sinead Murphy has mentioned already, a gap analysis carried out by the INDI in March 2013 showed that 88% of the country has no access to a community based obesity treatment programme for children and their families. While children who are obese can be referred for individual dietetic consultation, this service is not available in all parts of the country. We do however have programmes developed in the community which reflect evidence and best practice, national and international. I shall provide an outline of the Up4it! programme which is a cross-Border prevention and management childhood obesity programme led out by Co-operation and Working Together, CAWT, and funded as part of INTERREG IVA funding. HSE West - Letterkenny, Youth and Family Services and HSE - Dublin north east, Cavan and Monaghan and the Border Counties Childcare Network, BCCN, were two pilot sites in Republic of Ireland with a further two sites in Northern Ireland. This was a multi-disciplinary programme with nutrition, physical activity, emotional well being and behavioural change components. There was a healthy lifestyles for families, prevention programme, with a child under five years. It was an eight week programme with two follow-up sessions at week 16 and week 36. There was also the Making a Difference management programme for families with an overweight-obese child aged eight to 11 years. This was a 12 weeks programme and had four follow-up sessions up to 48 weeks. Both parent and child attended the management programme. The programmes were designed to suit the families' needs, were skills based, for example, had cooking components, food labelling, shopping and were delivered in local community settings. More than 585 families participated over two years from 2011-2013. For the management programmes, 61% of the referrals to the programme were classified as either self referrals, community or voluntary group referrals, with 41% of participants referred by nursing staff, primary care teams or general practitioners. The programmes were fully evaluated by CAWT. Data analysis was completed by the Northern Ireland Centre for Food and Health at the University of Ulster. Its analysis of 146 children enrolled to management programme during quarter three to quarter 5 of the CAWT project showed statistically significant reductions in both body mass index, BMI z score and waist circumference z score levels over the course of programme and follow-up sessions to 48 weeks which showed a longer-term sustained weight change. There were also statistically significant improvements in their perceptions of their body image over the course of the programme and all other targets set at the beginning of the project were achieved. To see the human benefits of investing now and for the future of our children, we will let the words of our patients speak for themselves. The following quote is from a 12 year old girl who attended the programme in Cavan-Monaghan:

What I liked was finding out what was wrong with my diet. I was eating too much of everything; not eating enough fruit and vegetables and eating too much junk like all children my age! I liked knowing how to fix my diet and the dietitians helped with that. Since completing the UP4IT! programme, I have joined the athletics club but before the programme I would never have wanted to do anything like this. I am also playing indoor soccer and thinking of joining the local GAA club. My diet and the family's diet is also healthier.

From an effective treatment view a community programme costs approximately €600 per family per year based on 15 families per programme. For every family going through the programme there is a multiplier of beneficial effect. The positive effects of the psychology, nutrition and physical activity affects others in the family. So taking the average family of two adults and two children, the actual cost is €150 per person. This represents very little investment for a huge potential saving in both human and monetary terms.

The reality is that even though we have evidence-based, best practice programmes on our doorstep, they are not being sustained. The Up4it! CAWT funding ended in March 2013. While there are small pockets of local funding being provided in a number of locations throughout the country to promote obesity programmes there is no dedicated, sustained funding to tackle this issue. In our local area, HSE west in Donegal, Sligo-Leitrim is exploring ways to sustain the project using a community development approach partnered with primary care teams but we urgently need for the Department of Health and the HSE to commit to resourcing the roll-out of successful models of best practice in the community and to ensure these programmes are incorporated into the policy document.

In Northern Ireland the project's programmes, CAWT, have been extended for a further one year delivery by the Public Health Agency while it puts in place in place its longer-term plans. The project's programme approach and outcomes will however shape the Public Health Agency's future specification for children's programmes.