Dr. Grace O'Malley:

On behalf of the families who attend the W82GO! Weight Management Service at Temple Street Children's University Hospital, and its staff, we thank the Chairman and the committee for the invitation to present on the challenge of addressing childhood obesity. Temple Street hospital, as a national acute paediatric hospital, sees up to 145,000 children per year, promotes healthy lifestyles for all children, which includes the prevention of overweight, obesity and dental decay and the promotion of a healthy diet, exercise and optimum dental health, in addition to treating multiple clinical conditions.

I am joined by representatives from the W82GO! multi-disciplinary team, namely, Dr. Sarah McGuire, senior clinical paediatric psychologist, Ms Nicola Sheridan, clinical specialist physiotherapist in paediatrics and Ms Michelle Strahan, senior medical social worker in child protection.

I will begin by contextualising our role in childhood obesity in Ireland and highlighting that we can represent only one small part of a larger discussion related to the complex social challenge of obesity in children. As such, we will focus solely on the treatment of clinical obesity in children and adolescents and recommend that additional stakeholders are invited to present on other aspects related to this issue.

The W82GO! clinical service was established in Temple Street hospital 14 years ago and, as with many worthy endeavours, the initiative was commenced without dedicated clinical funding but survived on staff commitment and research funding from the Temple Street Foundation and the Health Research Board of Ireland. Thereafter, temporary seed funding from the Health Service Executive was secured and service development was facilitated.

Since 2017, some funding has been provided by Temple Street hospital, thanks to the vision and growing understanding of the childhood obesity problem by the hospital's executive team. This understanding is founded on scientific evidence, including some stark facts. These include the fact that 20% of children and 25% of adolescents in Ireland are overweight or obese; the fact that children with obesity are at increased risk of health complications at an early age; the fact that admissions to UK paediatric hospitals for weight related issues have quadrupled over ten years; and the fact that children with obesity are more likely to develop serious adult diseases, such as type 2 diabetes, cardiovascular disease and many cancers.

The most recent data from the Irish arm of the WHO childhood obesity surveillance initiative, COSI, study run by the national nutrition surveillance centre at UCD, reveal that the estimated number of primary school children with clinical obesity and morbid obesity is around 6.5%. From Growing Up in Ireland data we know that, in addition, approximately 6% of 13 year olds have clinical obesity. This means an estimated 80,000 children and adolescents in Ireland have clinical obesity. The rates of clinical and morbid obesity are nearly double in schools with high levels of disadvantage. This is particularly worrying because these children are even more at risk of morbid obesity and cardiovascular ill-health in adulthood.

In Ireland, those with clinical obesity can receive multidisciplinary treatment at Temple Street. However, they currently have to wait nearly two and a half years to see the treatment team. For adolescents who will age out of paediatric services, this is particularly unacceptable.

A multitude of comorbidities are associated with obesity. An estimated three quarters of children will develop health complications at an early age, including physical and mental health complications. In Temple Street, we are conscious of the impact of childhood obesity on families. We approach this issue from the perspective that family re-education and support are essential elements in changing the eating and exercise patterns of our patients. We are also conscious that this can be particularly difficult for families with financial challenges or who have complex social circumstances. We work to support families to address issues that can cause barriers to the successful treatment in the child’s home.

The UN Convention on the Rights of the Child demands that those who are already obese and who may have comorbidities must have access to early treatment in childhood in order to avoid progression of associated conditions. The most recent estimate of the lifetime economic and health care costs incurred due to childhood obesity indicates that the amount involved is over €4.5 billion. Treatment needs to be available for all children when and where they need it. Research tells us the intervening early and in a holistic manner is essential if we are to manage this condition. A staged approach is recommended based around the needs of the child.

The children of Ireland urgently require timely access to treatment in primary, secondary and tertiary care. At primary care level, GPs and public health nurses who are interested in this area must be provided with the appropriate resources to treat obesity including access to practice nurses and to the paediatric health and social care professionals, HSCPs, working in the community. They often deliver the bulk of childhood obesity treatments. In addition, public health nurses will be unable to identify and act for infants and young children at risk of obesity if they do not have funding and staff dedicated to the delivery of infant and child health.

At secondary care level, any child in Ireland suffering with the physical or mental health comorbidities of obesity needs timely access to a general paediatric service. Areas with large populations - for example, surrounding the satellite centre currently being built at the Connolly Hospital site and the planned centre at the Tallaght hospital site - need integrated services which must be clearly planned and implemented in the children’s hospital group as a matter of urgency. Only then can we ensure better access for those most severe coming into tertiary services.

At tertiary care level, discussions on obesity service provision have commenced between the HSE and the Children’s Hospital Group, CHG. However, transparent planning and implementation engaging all those involved in the care of these children is needed. Of particular concern is the lack of health and social care professional involvement at executive level in the CHG. This will no doubt have a direct impact on children with obesity whose care is, in the main, delivered by HSCPs. New services at the new children’s hospital will also need to plan for the inclusion of bariatric procedures in line with best practice guidelines for those adolescents most severely affected. My colleagues will now update on our service in Temple Street and on progress to date in the area of childhood obesity.