Dr. Aoife Brinkley:

I would like to pick up on the issue of personal responsibility and parental responsibility raised by Deputy Byrne and Deputy Fitzpatrick. That is an important issue. Those of us in this room, as clinical experts working in this area and as public representatives, have a responsibility to understand this issue. For parents, the issue of blame is devastating and as they become aware of the issue when they come in to hospital services, for example, they quickly take on that blame. That can be devastating for a parent and can make it very difficult for them to address the issue in an effective way. We have a responsibility to address that.

The issue of self-blame ties in to the issue of weight bias. As a society we are biased towards children and adults who are overweight. There is evidence for that internationally and in Ireland. As clinicians we often hold that bias. As parents we may hold that bias. We must be aware of that, and we must fight against it. One of the ways we can do that is to communicate the fact that this is a complex issue. It is not a simple issue. It does not have a simple solution. If we buy into the idea that it is simple and straightforward for parents to address this issue, that in itself can make the issue worse. If parents, in trying to address the problem, meet a clinician for a once-off consultation, is given advice and sent off to put that into practice, they are likely to fail. Some parents will succeed but if there is a complex background to the child's obesity, they are likely to fail. That means they are less likely to try to address the issue again in the future. The message that gives to the child is also very difficult and devastating.

We must understand that this is a complex issue. Many of the children we see come with myriad difficulties associated with and underlying their obesity. From my perspective, the emotional and psychological issues are paramount in the work I would do and they can represent significant barriers for the child and for the family in tackling this issue. If children are self-conscious about their weight or have experienced teasing, which the majority of the children we see have experienced, they are less likely to feel able to go out and play, go for a jog in the park or go for a run because they are well aware that other young people the same age as them may target them and call them names, point to them or talk among themselves and exclude them. Those are the real issues with which these children are dealing.

I reiterate that we have a responsibility to understand the complexity of this issue and the need for a complex response, not just simple messages. Obviously, they have a role to play but the children already obese and overweight need multidisciplinary input. They need input that recognises the psychological impact of the difficulties with which they are dealing, and the parents need support in dealing with what is a complex issue.

On the issue of clever funding, we are well aware of the restrictions on available funding. From our perspective in Temple Street children's hospital, we have had queries about information and training from professionals working within other hospitals, public health nurses and people working in the community. We cannot provide that currently because of the limit in our own resources. What we can provide is not sufficient. We need resources and funding to roll out that training. That is one way of providing clever funding because it is a minimal spend for a large impact.

On the issue Ms O'Malley mentioned about schools, because of the complexity of the issues we need multiple responses. There is a role for schools to play. There is a role for us as clinical services and for community services to play. There is also a role for prevention.