Dr. John Devlin:

On behalf of the special action group on obesity, SAGO, I thank the Chairman for allowing us to make this presentation to the joint committee on this major public health challenge to society. I am joined by Professor Donal O'Shea, Dr. Nazih Eldin from the HSE, Professor Mary Flynn from the Food Safety Authority of Ireland; Dr. Cliodhna Foley-Nolan from safefood, Dr. Catherine Woods from DCU, and Sandra Barnes from the Department of Health.

The levels of obesity and people being overweight have increased at alarming speeds in recent years, so much so that obesity has been termed a global epidemic by the World Health Organization. The problem was aggravated in recent years by our changing social, economic and physical environment, a dramatic reduction in the levels of physical activity and our changing dietary patterns. Across Europe childhood obesity is reaching epidemic proportions. It is well known that diets excessive in energy combined with physical inactivity are the key contributors to obesity. However, as acknowledged by previous speakers, the relationship between these factors - what promotes obesity - is complex. We acknowledge that problem.

There is no harm in reminding ourselves of some of the stark facts we face. Various studies have shown that children as young as three years are overweight or obese and this pattern continues as children get older. One in four seven year olds is also overweight and obese and for teenagers, the figure is one in five. This is of concern because of both the short and long-term effects, not only in childhood but also in later life. In the short term we are aware of conditions such as high blood sugar causing diabetes, high blood pressure which contributes to diabetes, and heart disease. In the longer term the effects of obesity include heart disease, stroke, type II diabetes and some cancers. These are conditions we would normally associate with people who are quite old. To compound these effects, many overweight children grow up to become obese adults. The prevalence of obesity in adults has risen steadily in Irish society, so much so that some 61% of the Irish adult population is either overweight or obese. In 1998 the corresponding figure was just 44%. This indicates a trend.

We have discussed the issue of diet. We have very good information from nutritional surveys and what these show us is that approximately 60% of infants are snacking on chocolate, biscuits and crisps between their main meals. Approximately 40% of older children and teenagers eat sweets daily and one in four drinks fizzy drinks at least once a day.

With regard to physical activity, approximately one in four adults takes no physical activity and approximately only half of children exercise four or more times a week. A particularly noticeable trend is that there is a fall-off in physical activity among older girls. For example, only 10% of girls aged 15 to 17 years had exercised during the seven days previous to being asked. The figure is a little better for boys in that one out of five had exercised.

It is well recognised by the Department and the Minister that there are a number of chronic conditions related to obesity and people being overweight and that there is also an impact on physical and mental health. The Minister established the special action group on obesity in 2011 to tackle this growing problem. Members have met some of the representatives of the group today, but we also have representatives from other Departments such as the Department of Children and Youth Affairs and the Department of Education and Skills in recognition of the multisectoral element to this challenge.

On what we can do, some years ago the OECD looked at the impact of obesity prevention strategies and concluded that the most efficient and effective interventions happened outside the health sector such as in education settings, the workplace, fiscal measures, food labelling and advertising. Where the health care system has a role and has its greatest impact on obesity and related conditions is in focusing on high risk children and adults. This is where it plays an important role. In order to take a multisectoral approach and focus on high risk individuals, our group is liaising with Departments and organisations in a cross-sectoral approach to help halt the rise in the numbers who are overweight and obese. The issues we are dealing with include calorie posting in restaurants, the impact of a levy on sugar sweetened drinks, the marketing of food and drink to children, the supply of products in vending machines, the detection and treatment of obesity, healthy eating guidelines and the promotion of physical activity. These give just a flavour of the work we do. I would like to expand briefly on one or two of these measures.

We have identified calorie posting as being an important element as a means of educating the general public on the calorie content of menus. Following public consultation and in response to the Minister having written to fast food restaurants earlier this year, the Food Safety Authority of Ireland launched a major public consultation exercise which resulted in over 3,000 responses. This has demonstrated to us that the majority of consumers and some businesses want calorie labelling. We welcome that support. There is also broad support for this type of initiative and, together with the FSAI, we are working on an implementation plan.

The issue of sugar sweetened drinks has been raised. It has been estimated that these drinks contribute approximately 5% of total daily energy in the diets of Irish children. This equates to something between 70 and 140 calories a day. On my way here today I stopped at a shop to look at some of the high energy drinks which equate to 200 or 250 calories per can. This year we established a steering group to conduct a health impact assessment of the health and economic aspects of introducing a levy on sugar sweetened drinks. In the summer the Minister launched a stakeholder day. The health impact assessment is close to completion and when completed, it will be brought to the Minister for further consideration and action.

During the summer the Minister launched the healthy eating guidelines, a copy of which I have left for committee members interested in looking at them. The guidelines are for the general population and inform people on the food and drink choices for a healthy lifestyle and set out in plain and simple language the food servings we need to maintain health and well-being. A new emphasis is being placed on food servings from the top shelf of the food pyramid and alcohol is listed for the first time as a significant contributor to calories. This is something of which many are not aware. The physical activity guidelines were launched a few years ago and we are now working on a physical activity plan. There are many good examples of local initiatives, on which we need to build. My colleagues will be happy to provide more information in the discussion that will follow our presentation.

The issue of a broader cross-government approach was raised. It is worth noting that the Department is developing a new health and well-being framework. This will set out goals for improved health and well-being which are relevant for every sector and everybody's responsibility. It will provide for new arrangements to ensure collaboration and co-operation between sectors such as children, social protection, education, housing and the environment. Many of the determinants of health lie outside the control of the health care setting such as transportation, education, workplaces and so on. Priority issues to be addressed under the framework will include implementing our tobacco policy and work on alcohol, nutrition and physical activity levels. This year we are also starting a new health and well-being survey which will allow us to measure in much more detail health and lifestyle trends across the adult population. We include in this children from as young as 15 years upwards.

The trends in obesity and people being overweight are a major source of concern. In Ireland, as in other countries, we have crossed a threshold where chronic diseases have become a challenge as great, if not greater, as those posed by communicable diseases approximately one decade ago. The rising burden of chronic disease is very much due to behavioural factors. It is due to what we eat, how we exercise, whether we smoke and high levels of alcohol consumption, all of which is amenable to prevention. The focus in the SAGO is to build on those actions previously identified, the good work done by the obesity task force a number of years ago, various health promotion strategies and the cardiovascular strategy laid out two years ago which set out clear nutrition and exercise targets. We want to move forward on all of these through our work.

A slide was presented on the complexity of obesity and the range of measures involved. The question raised was whether we were singling out a particular measure over another. The answer is no. We believe no single measure will reverse the trend in people being overweight and obese and that a combination of measures will make a difference in dealing with this challenging public health issue.