Professor Michael Turner:

One of the problems with voluntary fortification in terms of specific food categories is that folic acid was being put into a large range of foods but at variable levels and in a very haphazard way. The recent study is also very enlightening because when one looks at the big six supermarkets in terms of market share, two of the six have entered the market in the past ten years. One of the big German conglomerates fortifies its food. The other does not. They now have 16% of the market share. They have foodstuffs that are very price sensitive and are likely to be availed of by those who are socially disadvantaged. The public is not aware of these facts. It is not aware that a certain food was fortified in the past but is not being fortified now. That is unfair on women who are of child bearing age. The women will often look at the labels and see that it is fortified but when they buy the same food six months later they will not look at the label again to see whether the company has continued to fortify the food. There is a responsibility on the food manufacturers to notify the public in the first instance and the health care professionals and policy makers, who should be aware of such changes, if they propose to make changes in the voluntary fortification of foods.

In terms of specific food categories, it is different when it comes to mandatory food fortification. In general, governments world wide have generally focused on flour. That is what has been done in North America, on the basis that most people eat bread. Again we need to be conscious of the fact that people's food habits are evolving over time and for example a lot of women have changed to eating snack bars on the way to work or for lunch and are not eating bread to the same extent as in the past. With the mandatory fortification programme, one cannot assume that food eating practices are constant and that they are the same for women of child bearing age compared to women or men in other circumstances.

I will address Deputy Kelleher's question on obesity levels. Again Dr. McKeating has recently published a paper in the Scandinavian journal which shows that one in six women booking for antenatal care in the Coombe Women and Infants University Hospital is now obese. The patients attending the Coombe number one in eight of everybody born in the Republic of Ireland, so it is a representative sample. Dr. McKeating's research indicates that the obesity levels in the country are stable. What is worrying is that she also was able to demonstrate that 2% of the population are morbidly obese and have a body mass index of greater than 40. In absolute numbers it has gone up 50% in five years. This is very challenging at several levels and has resulted in a major increase in the number of women with gestational diabetes.