Dr. Sinead Murphy:

We are very grateful to have the opportunity to present to the joint committee on the issue of childhood obesity. Before reading the points we submitted to the committee, I would like to set the scene a little, as I am sure the previous group did and Professor Kelleher has just done. I am quoting largely from a Government publication, A Healthy Weight for Ireland: Obesity Policy and Action Plan. It states obesity is a largely preventable disorder. It states only 40% of Irish people are a healthy weight. It states 25% of schoolchildren are overweight or obese, albeit there mayb e a little stabilisation. That means that between 80,000 and 100,000 children at school are overweight or obese. The risk is 7% higher among socially disadvantaged children. That is really important when it comes to aiming treatment for these children. The problem is that there may be an attitude that many of these children will become obese adults which they will and that then they will run into trouble. It is important to realise we do not need to wait until then. The children are in trouble now. As Senator Joan Freeman said, 40% of children are having huge psychosocial difficulties. They have fatty liver disease. They have an average age of ten years. They have high cholesterol. They have high triglycerides. They have high insulin levels, which means that they will - not may - develop type 2 diabetes. They are hypertensive. These are all issues that we traditionally associate with unhealthy adulthood. These children - 80,000 of them - have them now. They may not make it to adulthood unless we do something about it. It is critical. We are seeing it all the time. Our waiting list is uncontrollable such is the need for some treatment for these children and their families.

We can all quote figures and it all sounds terrible and very dramatic. I will tell the committee about three particular cases - obviously I will not reveal names - of children whom our team and I have come across recently. The first relates to a boy who came into my clinic at the age of four years. When he arrived, I thought he had walked into the wrong clinic because I thought he did not look overweight. By the time children look overweight they are far too overweight and most of the children who come to my clinic are in that category. He had been weighed and measured, as they all always are. We plotted his weight and height on a centile chart to see how he compared with other children of his age. He was not, in fact, overweight; he was in the high centiles but not overweight. I started to explain to his mother that, unfortunately, he was in the wrong clinic and that he was probably meant to attend a general paediatric clinic but that we would try to help her out. At that point she took out her phone and said he was overweight. She showed me photos of him going back for the previous two years since he was just over two years old where he was, undoubtedly, very overweight. I asked her what had happened and what she had done. She told me that she had met the public health nurse who told her what to do and she had done it. I asked her what she had done. She said that when they went to the park, the other kids and moms might have crisps, biscuits or little cartons of Ribena and so on, but he could not do that because he had a predisposition to being overweight. Luckily for her, she had come across a well trained and well motivated public health nurse who had given her advice when she needed it and she had taken it. She just did not know because it was what lots of mothers were doing, but she had changed what she was doing. She brings grapes to the park and only gives him water. He was saved by the public health nurse because he was lucky. It would be great if we could do that a little more.

The next child was aged nine years when I came across her. She had been attending different services in the hospital for a couple of years. She weighed 89.5 kg, which is more than what most men in the room weigh. She was in a terrible situation in that her mother also had psychiatric comorbidity. I became involved because people thought it was a child protection issue. The child was putting on weight because her mother was not doing what she should have been doing. Her mother was feeding her when she should not have been doing so, not allowing her to exercise, etc. As I was not comfortable with the child protection thing, we admitted this little girl to Temple Street Hospital at a huge cost for two weeks. During the two weeks she received 800 calories a day. She was exercised five times a day by physiotherapists and care assistants, taking walks and spending time in the physiotherapy gym. During the two-week period she lost 1.5 kg, which was so little that essentially it was not going to make any difference to her health. That was because we had missed the boat. This type of treatment will not work for a little girl who has reached that stage.

The other case is even worse. It involves a boy from Cavan who comes to see us. He is 13 years old and in first year in secondary school. He weighs 152 kg which is almost 24 stone. He has a really unhealthy lifestyle. He plays the Xbox a lot. He eats takeaways more than one would regard as healthy. He drinks fizzy drinks. His only social interaction is with his friends on the Xbox. I have no idea how it works and how they do it on Xbox. He is socially isolated otherwise because he weighs 152 kg. He says to me - we know that it is true - that all of his friends also do it, but they do not weight 152 kg. He has hyperinsulinism, a fatty liver and high blood pressure. He will not make it to adulthood unless he has bariatric surgery, which is the only treatment option for a boy such as this. However, he cannot because we do not have bariatric surgery available for him and will not have for another seven years. I do not know if he will make another seven years. That puts it in context and lets members understand the misery these children are suffering.

I will outline what we propose to do about it. We certainly need treatment options for the children concerned. There are two types. There is the behavioural model of treatment for children who suffer with mild or even moderate obesity such as the first little boy who will respond to such treatment.

We need the bariatric service. We need the whole service - the surgery and the psychological support before and afterwards for the other children, the 80,000 children who are in that situation. Nothing else will help. We are very pleased that there has been engagement with the new children's hospital, which understands this issue. The service planners are saying that there will be a bariatric service in the new children's hospital and we are delighted about this and very much welcome it.

They are the two different types of treatments we need. It is not only health. Like the previous speaker said, we need a whole systems approach to this. We need education. I am very involved at an educational level and we would try to educate our undergraduates across the health disciplines but we need education before that. We need it in schools. We need it everywhere. We need environmental planning so that these children can get out and exercise. Possibly, above all, we need regulation of the food industry and advertising around this. This is critical. Unless all of this happens, we will not tackle it successfully.

The other major issue is prevention. All of the speakers alluded to this. We need prevention and we need it early. It has been shown in the US that intervention at preschool level is too late. We need intervention the generation before. Some of that is beginning in terms of health promotion. We need to educate transition year students, not for they themselves, although they will pick up something, but for the next generation. That is where we need to go. It is definitely about pre-pregnancy. There needs to be a lot of investment in the prevention of obesity.

We welcome the initiatives that exist in terms of health promotion. The HSE has a healthy eating and active lifestyle programme. The island demonstration programme links to transition year. These are very welcome initiatives but they are only a start. Some of the previous speakers alluded to a national packed lunch policy for primary schools. That does not cost anything and would be very helpful. We half do it but it would be very easy to do a full-on version for everybody. We certainly welcome the sugar tax legislation and look forward to its implementation. We can see changes so there has been reformulation because, like a previous speaker said, the food industry is about making money. If they reformulate drinks so they can still make money, that is great. The kids are still buying the stuff but at least it has less sugar, so there have been changes. We would love to see the money that is made from the sugar tax legislation being reinvested into the treatment of childhood obesity. It seems obvious to us that this is what needs to happen. There needs to be investment that is significant and sustainable at Government level in the treatment of childhood obesity because the appointment of a national clinical lead on obesity and the setting up of a clinical advisory group - the Royal College of Physicians of Ireland policy group - cannot do anything unless we have investment behind us. The investment needs to be in both prevention and the two different types of treatment for these children.