Dr. Cliodhna Foley-Nolan:

Having been the director for human health and nutrition in SafeFood for the last ten years, I realise that childhood obesity is a very stubborn health issue. We further realise that childhood obesity has been almost completely normalised. We are no longer particularly impressed by the stark statistics. We almost see this as an insoluble or inevitable situation. A very interesting graph on the bottom of the short paper that we sent to the joint committee covers a period of almost 60 years from just before 1950 to just after 2000. It shows how the average weight of boys, whom we took as an example, has increased over that time. A 14 year old in 2000 was, on average, 14 kg or more than 2 stone heavier than a 14 year old in 1950. All of that is not healthy. Perhaps people were a little on the undernourished side in some regards in 1950, but we are over-nourished or unhealthily nourished now. That is where childhood obesity is.

I would like to comment on the way we are nurturing our children from the beginning. One in three pregnant women is overweight or obese. This leads to all sorts of problems from a health perspective for the mother and for the child and places a much bigger burden on services. There is increasing evidence of how much sugar and how few vegetables are in ready-to-eat baby and toddler foods.

Many primary schools have either an official or unofficial "no running" policy and no fridges for lunch storage. They have no water fountains. Many parents have mentioned the issue of lunch time interfering with play time, and it is something I experienced when my children were that age. Who will pick lunch over play? Children gobble something and put the rest into the lunch box before going out to play. It is counter-productive in the context of nutrition goals and a healthy environment for children. Parents struggle between one thing and another but two matters that have come to our attention. The first is the ubiquitous nature of treats. If children have their dinner, they get a treat but if they do not eat their dinner, they still get a treat. There is a treats cupboard, there are children's parties with play areas and even some sports facilities where it is practically impossible to avoid these products. The second matter relates to screen-based technology and the difficulty parents have with such devices. This fits into the obesity epidemic.

Children in disadvantaged areas eat less nutritious diets and there is a much higher proportion of fast food outlets in those areas. That gap is growing. I live in Cork but this morning I travelled in from south Dublin. Everything I saw looked rosy but that is not the full picture and the level of childhood obesity is growing in areas with people who are less advantaged. We must act further in this respect. Secondary schools are being targeted by fast food outlets with meal deals comprising carbohydrates, sugar and fat. It is an ongoing problem. It is the same with local shops and one cannot try to buy a bottle of milk or some petrol without being bombarded in newsagents, garage forecourts or supermarkets by these products. Children and parents are having it tough in trying to stay at a reasonable weight and level of health.

We continue to be members of the Government's advisory and strategy groups dealing with weight matters. The bottom line is there must be resourcing and implementation of A Healthy Weight for Ireland. Much has been done but we are at a plateau with childhood obesity, so the word "stubborn" definitely comes into it. We are at a ridiculously high level if one in four children is obese or overweight; if a primary school class has 30 children, seven of them are overweight or obese. If that were any other disease or condition, we would be more alarmed than we are. Although obesity is a disease, it does not require urgent treatment, and as a result, we find ourselves in the current position. As members indicated, blood pressure issues and pre-diabetes are occurring in children aged five, six or 15.

We have proposed a number of recommendations we would like to highlight. Without going into all of them, I can outline specific recommendations and we are particularly aware of their importance. There should be a dedicated percentage of the overall obesity budget for prevention, as it always tends to get less emphasis than treatment. Immediate treatment of extreme cases will always be an issue but unless we have a dedicated budget and resources for prevention, we will continue to have difficulties. Within that budget we should establish an approach that from an obesity perspective would be in line with what we know contributes to obesity. This includes diet and physical activity, with a ratio of 2:1. Diet is the principal factor but I could not be more supportive of physical activity, not only from an obesity prevention and management perspective but from mental health and other perspectives. It is nonetheless my job to emphasise that diet is twice as important as activity in the prevention and management of obesity.

How do we help parents? Currently it is a handy approach to blame parents if their children are overweight. That is simply not fair or accurate. We must provide parenting skills in order that parents can negotiate pester power and the environment in which their children are harassed to eat and seek too many treats or food that is not particularly healthy. Members emphasised the role of the parents in the community approach, and the approach is at this ground level. Cooking from scratch at home, for example, can be helped with a number of community cooking problems, such as Cook It. There are not enough of them and we need to fund and implement them as a norm in all communities, particularly those at less advantage. There is less cooking from scratch in those areas. Home economics in school should be approached in the same way as activity, with availability to all children. One could argue it is a gender issue, apart from anything else, that leads to boys not having access. It is also a normalisation issue.

There is the matter of schools recognising obesity. Given that we have school uniforms labelled as being for the same ages but which are considerably bigger than they were 20 years ago, there has been a visual normalisation of what is healthy. In the same way we look at eyes, ears, teeth and other indicators of growth in schools, we need to measure and weigh children as part of the development assessment routine.

I will hand over to my colleague, Dr. McGloin, who will deal with campaigns and how we have listened to parents.