Oireachtas Joint and Select Committees

Thursday, 15 November 2012

Joint Oireachtas Committee on Health and Children

Childhood Obesity: Discussion (Resumed)

10:10 am

Photo of Jerry ButtimerJerry Buttimer (Cork South Central, Fine Gael)
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I thank members for their patience and forbearance and I apologise to our witnesses for the delay. We had a debate on the cessation of smoking within the Leinster House campus, which also comes under our remit.

We are holding our final hearing on the issue of childhood obesity. I welcome Dr. Muireann Cullen, Nutrition and Health Foundation; Mr. Barry Walsh, Institute of Leisure and Amenity Management, ILAM; Ms Christine Moloney, ILAM and chief executive officer of Leisure World, Bishopstown, Cork; and Mr. Trevor Walsh, a food critic who has written extensively on this topic. We have held a series of meetings on this issue, which is a priority in the committee's work programme for 2012. The opening statements should be no longer than eight minutes.

I draw attention to the fact that by virtue of section 17(2)(l) of the Defamation Act 2009, witnesses are protected by absolute privilege in respect of their evidence to this committee. However, if they are directed by the committee to cease giving evidence in respect of a particular matter and they continue to so do, they are entitled thereafter only to a qualified privilege in respect of their evidence. They are directed that only evidence connected with the subject matter of these proceedings is to be given and they are asked to respect the parliamentary practice to the effect that, where possible, they should not criticise or make charges against any person, persons or entity by name or in such as way as to make him, her or it identifiable. Members are reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the Houses or an official by name or in such a way as to make him or her identifiable.

I call Dr. Cullen to make her opening remarks.

Dr. Muireann Cullen:

I thank the committee for the invitation. I am a dietician and manager of the Nutrition and Health Foundation, NHF. I have been with the foundation since 2008. Prior to that, I worked in hospital and general practitioner settings, food law, research, private practice, public health, nutrition and the food industry.

The Nutrition and Health Foundation, NHF, was set up in 2005 and represents a coming together of invited organisations working in the areas of nutrition and physical activity as well as academics, health care professionals and members of the food and beverage industries. Funding comes from the food and beverage industry members and to date over €2 million has been invested by this group. Our members include Glanbia, Mars Ireland, Coca Cola, Danone, Kelkin, the Irish Nutrition and Dietetic Institute, the Irish Society of Chartered Physiotherapists and academic institutions such as UCD, UCC, DCU, St. Patrick's College in Drumcondra and St. Andrew's College. The consumer is the principal concern of the NHF and the primary objective is to promote a healthier Ireland through evidence-based information and co-operation between the different sectors, namely, industry, internationally recognised scientists, key health professionals, Government and its agencies and consumers.

Obesity, as everyone knows, is at epidemic levels in Ireland. The key to a healthy weight is maintaining a balance between energy in and energy out and this is currently out of kilter. We know from research over the last 60 years that there has been a reduction in the amounts of calories and fat being consumed but there has also been a huge reduction in physical activity levels in both adults and children. We need to encourage and support parents to change their lifestyles. Obesity is multifaceted and we must support parents in as many ways as possible.

The NHF takes a multi-stakeholder approach in that it brings together a number of different organisations, both public and private sector. The success of the heart disease project in North Karelia in Finland is an example of how effective the multi-stakeholder approach can be. Our focus within the NHF is childhood obesity and tackling that problem requires a multi-stakeholder approach and joined-up thinking, particularly regarding health promotion messages. In order for the message to be cohesive and effective there must be leadership and a national strategy. At the moment there are many anti-obesity initiatives happening all over the country but the picture is very piecemeal. We must have a national strategy which brings together as many sectors as possible. We also need a cultural change. At the moment there is a perception that healthy eating and adequate physical activity requires a lot of work. However, we brush our teeth once or twice every day and were taught to do so at a very early age. The benefits of a healthy diet and physical activity can also be taught at a very young age and then continue on through the life cycle.

In terms of the aforementioned life cycle, pregnant women should be a priority. We know that a good diet during pregnancy is very important for the health of both mother and baby. Foetal origin of disease is being confirmed more and more by research. We know that what a mother eats before and during pregnancy has an enormous impact on her baby and on his or her health in childhood and into adulthood. Folic acid is a good example of this. We know from the work of Professor Fionnuala McAuliffe, for example, that 78% of pregnancies are planned but only 35% of women are taking folic acid and this has an enormous impact in terms of neural tube defects. It has been shown clearly that diet, lifestyle and levels of physical activity during pregnancy have an enormous impact. Women who are overweight and gaining weight during pregnancy are at increased risk of Caesarian section and their babies are at increased risk of being born large-for-date and of developing obesity, diabetes and other chronic diseases. In that context, pregnancy is a key area for investment.

We also know that the choices mothers make after delivery are critical. Breast-feeding, for example, is the best possible form of feeding but our breast-feeding rates are extremely low. At six weeks after delivery only one in four women is still breast-feeding. Weaning is another important stage and we know from research that many infants are weaned far too early and are given foods that are high in salt, sugar and fat. In that context, we must support and advise parents all the way through the life cycle. The GP setting presents the best educational opportunity because mothers-to-be attend their doctors to have their pregnancies confirmed. At that stage, the GP goes through the ante-natal care programme and can emphasise the importance of a healthy lifestyle and diet.

Children themselves must also be a priority for us. We know from a recent study by the Irish Universities Nutrition Alliance, IUNA, that almost one in four children aged between one and four is either overweight or obese and the rate is only slightly lower for older children and teenagers. It is very important to note that as children get older, their physical activity levels decrease and this is particularly true of girls. We know from data produced by Safefood that, on a day-to-day basis, health is not really a major concern for families. Over-consumption of food and a lack of physical activity is the norm but that must be changed. Children learn behaviour from their parents, not just in terms of diet and exercise, but in a broader sense. We must change the culture among adults and children and we must start with the children at a very early age. We must support parents to have more healthy and balanced lifestyles. We must also create environments that lend themselves to spontaneous play for children, namely, more parks and playgrounds that are safe so that parents are happy for their children to be out and active.

There are a number of worthwhile initiatives being undertaken by schools and, indeed, schools are a wonderful setting for encouraging behaviour change. Initiatives such as healthy eating guidelines, food dudes, active green flags and so forth are excellent but most are carried out on a voluntary basis. We should consider making such initiatives compulsory in all schools so that there is a standardisation across the country in terms of nutrition and exercise. If schools could exert some control over what children have in their lunch boxes and over their levels of physical activity, this would help enormously. We know that as children get older, especially around the time of State exams, less emphasis is placed on the importance of physical activity. We must ensure that children continue to have adequate levels of physical activity which is beneficial in terms of their physical and mental health. Research by IUNA shows that lunch box foods contain relatively more sugar and salt and less protein, dietary fibre, vitamins and minerals than foods eaten during the rest of the day. The food eaten at school is typically prepared at home so we must encourage parents to provide better nutritional options. Home economics should be a key subject at school. As well as nutritional education, it develops basic food preparation and budgeting skills. Students leaving school would then know how to cook basic foods and would have a better chance of eating well at third level.

The NHF, in conjunction with our European colleagues in the European Nutrition Foundation network, has developed a European food framework, for use in schools and other settings, which focuses on nutrition, physical activity and energy balance for five to 16 year olds. We have also worked with the Restaurants Association of Ireland in developing an initiative called Kid Size Me, which encourages restaurants to provide child-sized portions of adult meals, at a reduced price, in addition to what is provided on the children's menu, thus providing children with greater choice. We have also been working with the Camogie Association to develop a booklet on nutrition and physical activity for teenage girls. The booklet is by camogie players, for camogie players and is based on the work of focus groups and questions that arose there.

Other work in which the NHF is involved does not focus on young children but aims to influence policy makers and parents who are key in the dietary and lifestyle habits that are developed by children. An example of this work is our seminars which examine the role of the public and private sectors in tackling obesity. These are about having thought-leadership and we bring in national and international speakers from the food and beverage industry, NGOs and academics working in the areas of nutrition, lifestyle and physical activity.

Those attending would be from different sectors as well. We have a workplace well-being campaign - this is a health promotion initiative in the workplace to influence parents on the choices they make during the day and I hope they will bring this home as well. We have been working with Mr. Don Rice, catering manager in Leinster House, who retired recently, for the past number of years in the Dáil in regard to options and portion size. We have been doing health lifestyle sessions for Members and staff as well. It is very much a case that people can come up to me and talk to me about it.

We also have a healthy eating week, "Eat Smart" around healthy eating, which does not have to be expensive or complicated. It can be easy to do once one plans for it. This year in conjunction with the Camogie Association we did "Move Smart" a campaign to get people to get active and encouraging as many people as possible to be out and active.

There are many influences coming into play on the issue of obesity. We all have a role to play and need to come together in a national approach to the problem. We are all responsible. We need to recognise our responsibility and work together rather than in our individual silos. We need to have a national movement to combat obesity.

10:25 am

Photo of Jerry ButtimerJerry Buttimer (Cork South Central, Fine Gael)
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I thank Dr. Cullen for her very informative presentation. On behalf of the joint committee may I extend our best wishes to Mr. Rice, the former manager who just retired. I am very much aware that Dr. Cullen and her group worked with Mr. Rice in promoting a healthy Leinster House complex. A signature part of her achievement is that we have a healthy option on the menu. This is a good example of how a collaborative approach to healthy eating can be achieved.

I welcome Mr. Trevor White, who is the author of a best selling restaurant guide but, more important, has written extensively on the matter under discussion and also on chefs, restaurants and the politics of food production in Ireland.

Mr. Trevor White:

I thank the Chairman and members of the joint committee for this opportunity to appear before them. In the 1980s my mother owned a restaurant called Whites on the Green. Some Members are old enough to remember it. I was the little boy hiding under the coat rack. Many years later I published The Dubliner 100 Best Restaurants, which was the best-selling restaurant guide in this country. More recently I have written about the politics of food production.

I am not here in a professional capacity but as the father of two small boys. I am worried about bringing my boys up in a country with one of the world's highest rates of childhood obesity, a country in which an entire generation of children are in danger of dying younger than their parents. My views of childhood obesity will strike some Members as extreme. I believe that one day the cost of treating the diseases resulting from obesity will become so great that people will wonder why we did not act sooner. The idea that dangerous food was once advertised directly to children will strike us all as properly embarrassing.

Childhood obesity is not yet a major political issue in Ireland, which is the reason that industry still controls the terms of the debate and why my views are still regarded as eccentric. In that regard I have read the submissions to the joint committee with great interest. Time and again, members have been told how complex the issue of childhood obesity is and have heard many claims about product reformulation, the importance of the stakeholder approach, partnerships with industry, but most of all they have heard how consumers much change their behaviour. By 2030 more than half of Irish adults will be obese, yet right now the food industry is engaged in a very expensive campaign to blame the public for the problem. I find it truly remarkable that obesity is still framed as an issue of personal responsibility. This line seems plausible only because it is so familiar. We tolerated the same argument from big tobacco companies for decades and it is demonstrably rubbish. After all, the incidence of obesity increases year after year. Were Irish people any less responsible in 2011 than they were in 2010? Of course not. Blaming the victim is just an excuse to let industry off the hook.

Let us speak frankly about this public health crisis. Unlike many of the people who have come before the committee, I believe it is not nearly as complex as they suggest. Broadly speaking there are three options. Option one is to take the advice of industry and tighten those belts and build more gyms, jog and cycle to work, play camogie. These are all laudable goals in their way. There is room for the personal responsibility argument, as old and lazy as it is. After all, no one seriously proposes that people should exercise less - stretching those legs is an obvious good, as is full employment, peace in our time, the pot at the end of the rainbow. As a strategy for survival, it is simply ineffective. Yet this is all one ever hears, the same weary mantras, and when any form of Government intervention is mentioned, industry throws its arms to heaven and says that it will not work and it will cost jobs. Let us unpack that. If it will not work, why will it cost any jobs? The fact that we are only tinkering around the edge with talk of self-regulation and something as disingenuous as an advertising watershed speaks to the success of industry and our failure as a society.

If one wants a tangible example of the insincerity of what I am referring to, just consider the name of an industry lobby group that made a presentation this morning, The Nutrition and Health Foundation. This fake movement -----

Photo of Jerry ButtimerJerry Buttimer (Cork South Central, Fine Gael)
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I advise Mr. White that he is speaking under privilege and words such as "fake movement" are not necessarily correct. I ask Mr. White to be careful in his use of language for his own sake and to protect the people who work in these organisations.

Mr. Trevor White:

With respect, Chairman, the organisation is well aware that I can substantiate that claim. It sounds so cuddly, warm and uncontroversial until one begins to look a little deeper. The Nutrition and Health Foundation claims to put the interests of consumers before everything else, yet it cares so much about Irish consumers that it will not let them join. I know this because I tried to join the Nutrition and Health Foundation. After seven months of equivocation, my application was flatly rejected.

Option two is to ask industry to be nicer, to reveal the damage they are doing to children, beg them to go easy on the fats, salt and sugar. Sadly this policy has proved futile for nearly 30 years and in that time the incidence of childhood obesity has shot up alongside high blood pressure, heart disease, type two diabetes, stroke and certain forms of cancer. Why? Quite simply because corporations put short-term profit before all other concerns.

The third option is that the legislators can intervene, that is the Members can convince the Minister for Health to introduce the legislation that will tackle this problem and thus secure a place in history. This is not just an Irish issue, this is a problem throughout the developed world. There is a profound need for leadership on obesity and the actions of members could have wide reaching consequences.

Politicians provided leadership when they introduced a tax on plastic bags and banned smoking in the workplace. That is the kind of influence that politicians could exercise with regard to the issue of obesity.

It is heartening to note that the committee has taken submissions from good people. I particularly applaud the recommendations of the Irish Heart Foundation for a tax on sugar-sweetened beverages which would increase the price of such products. Such a tax should be at least 20%, not the rate of 10% mooted in the media last Tuesday. In my view the Irish Heart Foundation is being moderate in asking for an advertising ban from 6 a.m. to 9 p.m. I would go further. I agree with Deputy Dowds that we must ban the advertising to children of all unhealthy foods.

I note this week's decision by the Danish Government to abandon taxes aimed at curbing obesity. The lesson from that experience seems to be that it is much easier to tax specific foods, such as a tax on sugary sodas, than to tax at the nutrient level with a fat or sugar tax. I have in mind softer interventions such as the ban on large sugary drinks introduced by the mayor of New York, Michael Bloomberg.

If this were a truly civilised society, our children would never be exposed to advertisements for products that would make them sick. There would be a traffic-light coding system on the front of packs; we would make schools healthier, more protected environments; we would impose a levy on sugar-sweetened drinks; and we would also promote physical activity. Supermarkets would be redesigned to give less prominence to foods that are high in fat, sugar and salt - what we euphemistically call the obesogenic environment. Internet and outdoor marketing in the retail sector treats children with contempt by cynically exploiting their intellectual immaturity. It is, frankly, morally despicable.

This committee has an opportunity to exercise the sort of leadership that separates statesmen from politicians. In doing so, its members will earn the respect and gratitude of Irish men and women who are only now beginning their lives and of children as yet unborn. However, if our politicians continue to fail to address this crisis or if their proposals are shelved or watered down because of the demands of the industry, the opposite will be true. History will judge them most unkindly. On behalf of my boys and of children throughout the country I ask members of this committee to show the world what leadership really looks like.

10:35 am

Photo of Jerry ButtimerJerry Buttimer (Cork South Central, Fine Gael)
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I thank Mr. White for his thought-provoking and analytical presentation. The final presentation is from the Institute of Leisure and Amenity Management, ILAM. I welcome Ms Christine Moloney and Mr. Barry Walsh. I served on the board of Leisure World with Ms Moloney for a number of years.

Ms Christine Moloney:

I thank the Chairman and the members for giving the leisure industry the opportunity to put the case that it is an important stakeholder in the implementation of obesity strategies. I have been in the leisure industry for 19 years, with most of those years spent working in large-scale facilities in the public leisure sector. Mr. Walsh has more than 20 years' experience in the private leisure sector in the UK and Ireland, based predominantly in Dublin.

ILAM is a not-for-profit organisation and a national employers' body for the leisure, fitness and recreational industry across 26 counties. We represent leisure centres in the public and private sectors, outdoor pursuit centres, community centres and providers of education to the industry. There are approximately 700 leisure centres across 26 counties of Ireland. This illustrates the scale of the number of facilities. We do not need more gyms or pools; we have plenty of people to help with the implementation of the strategy. As Dr. Cullen suggested, we must take a multidisciplinary approach instead of having silo mentalities, as has been the case where resources and personnel are duplicated and replicated. Our industry employs a broad spectrum of professional staff, including fitness professionals, cardiac rehabilitation and GP referral professionals, physiotherapists and swim instructors.

ILAM is a voluntary board whose main aim is to provide self-regulation for the industry and promote competencies throughout communities. We are very much embedded in our communities across 26 counties. We self-regulate through a white flag quality standard. We work with the HSE on child protection guidelines. We met with the Minister for Children and Youth Affairs to discuss the protection of children using our facilities. We have relationships with the Garda vetting bureau. All of our professional fitness staff are Garda-vetted. We operate a register of exercise professionals in order to validate their qualifications. Our leisure centres are accessible to all. We co-operate with partners in the UK, in Europe and internationally. These partner associations undertake research, lobby on behalf of the industry in order to improve participation and deal with societal health issues. Childhood obesity is not just an Irish issue; rather, it is a global issue.

The purpose of our presentation is to explain the opportunity that exists for our leisure industry to implement obesity strategies by means of our facilities and personnel. We have made assumptions that the diagnostic and intervention processes have been completed. We are here to show how these strategies can be implemented effectively.

Our industry is based on participation. Our facilities across the country are embedded in their communities. We need multi-level partnerships, collaboration and a common vision. I concur with Dr. Cullen's vision in this regard. We need commitment from all of the agencies, institutions and organisations to make this change and to increase participation, as mentioned on page 133 of the report of the Irish Sports Council. However, nothing is happening with regard to engaging these people and organisations. The reports are available. We are here today to say that we are able to help, and we ask the committee to let us help. We have the referral pathways, the competencies and the resources to provide pathways for obese and pre-obese clients before medical intervention is required. Anyone who watched the RTE television programme "The Obesity Clinic" last Monday night must have found it distressing. The people in the programme have to seek medical intervention because they have reached that stage. They may not have had the opportunity to get help from exercise professionals to improve their quality of life. Our industry is part of this multidisciplinary approach to increased participation. We provide a primary care solution.

The UK model known as MEND tackles obesity in the community, dealing in particular with children aged seven to 13 years. It is a multidisciplinary approach. Interventions include behavioural change by means of land-based and water-based activities, advice on nutrition and educational advice. Implementation is carried out in after-school settings, community groups, leisure centres and schools. This model has resulted in increased participation, reduced BMI and increasing self-esteem and confidence among the children involved.

I can cite a case from Leisure World. We were looking for a project to prove to our industry that leisure professionals can provide a sustainable and successful approach to citizens whose health issues need to be tackled. We were looking for participants who had never entered a leisure facility, whose BMI was over a certain figure and who were intimidated at the prospect of using our facilities. This was an adult-based project. We wanted to promote the fact that the leisure industry is a key provider of pathways and can offer direct access to members of the public who would benefit from professional exercise advice and support. The 12-week programme known as Project Weight Loss was born. We advertised in the hope of attracting 30 participants with BMIs over 25 who were inactive. The initial project was oversubscribed, with 120 applicants. Sixty participants were initially accommodated on the pilot scheme, which was supported through the Cork sports partnership. I have provided a slide showing the results achieved by the 60 participants. Every participant lost weight and size, by which I mean centimetres off their body measurements. Over the past three months, there have been 300 participants in the programme. Between 15% and 20% of participants did not complete the programme due to ill-health, life issues or a lack of confidence, but 40% of the 300 are currently independently exercising in a gym or doing some other activity because they have the confidence required to do so.

They believe they can do it. Forty per cent remain in contact with the programme. Currently, we have 45 participants in Leisure World on this programme. We could cater for many more but we do not have the resources in one facility to do that. Staffing resources are the issue. We believe there is demand to do three times as many at any one time in any one location. My point is that there are people who are looking for help, and we are here to help them.

Some of the participants' comments would include that the company of others in the same situation and proper instructional motivation resulted in their positive feedback; the staff are genuinely interested and are keen to help them improve their lifestyle; there was clear instruction from staff to improve without pushing them too far; they are delighted with the way they feel; and they are trying to adopt a new lifestyle to be fitter and healthier. One person said that movement is easier. Another person's comment was that their breathing has improved, they are able to exercise longer and their clothes feel a little looser. Those are basic benefits to people that mean so much because they got 12 weeks, intervention on a healthy, active lifestyle.

Our plan for the future, along with the Cork Sports Partnership, is to implement this project nationwide through the Institute of Leisure and Amenity Management, ILAM. We now have the Health Service Executive, HSE, health promotion unit in Cork engaged. It did not want to get engaged at the outset because it saw us as a profit-making organisation. That is far from the truth. Our aim is to get more people more active more often. It is not about money; it is about doing the right thing for our society. The HSE is now involved and it endorses the programme from the health promotion and dietician aspect.

The Cork Sports Partnership is continuing to support the initiative. We will start taking this project across our county and we will undertake a training leader programme with eight centres in the community. That is a pilot scheme in County Cork but our vision is to take that nationwide.

The project has proved that as an industry we can help. We have the capability to improve people's lifestyle behaviours. The pilot scheme has provided the hard evidence in terms of these facts, therefore, these are no longer aspirations. They are facts, and we can make a difference to people's lives.

In terms of the support our industry needs, we must be included. We must have a voice in this fight against obesity, and we are an important stakeholder in the implementation strategies. We must have support from key agencies such as the HSE to endorse activities and improve participation, and not see it as a profit making activity.

In terms of other ways our industry can be supported, many of our members have to charge VAT on teaching children to swim. That is not helpful. It is turning people away from becoming more active. Benefit in kind on leisure centre membership is also counter-productive. Health insurance incentives for people who take the time to become healthy and be responsible for their own health is also counter-productive.

In summary, the leisure industry facilities and personnel can support a family unit from the cradle to the grave with activities and education through a multi-disciplinary and collaborative focus. Page 135 of the Irish Sports Council's strategic advice document states:

We are putting our hands up to help. Our Industry is a great Resource but under Utilised at present.
Many public facilities in every county across this country were built using public moneys. Why are we not being utilised? Active children equals active adults. Again, it is a case of having more people more active more often.

10:45 am

Photo of Jerry ButtimerJerry Buttimer (Cork South Central, Fine Gael)
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I thank Ms Moloney for attending and for an excellent presentation. We will take questions now from Deputies Troy, Ó Caoláin and other members.

Photo of Robert TroyRobert Troy (Longford-Westmeath, Fianna Fail)
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I thank the contributors for coming before the committee and sharing their thoughts on this issue. They may be diverse but we will always have diverse opinions in a democracy.

I wish to make a number of points. I share the concern of the speakers about the figures quoted on obesity and the prediction that by 2030 half our adult population will be obese. Apart from the health and welfare of people the drain that will put on the Exchequer in the future is a serious concern, although it is secondary to our concern for people's welfare.

Mention was made of awareness in schools but highlighting the issue must begin at home. Given that a recent report by the Irish League of Credit Unions stated that families have only €100 disposal income at the end of the month, inexpensive, unhealthy food versus expensive healthy food is a major issue. Some families would love to give their children the healthiest food available but they cannot afford to do that. The primary aim is to feed their family.

From speaking to my constituents I am aware that the national playground policy of 2002 is quite successful in terms of playgrounds being installed in large urban areas and larger villages throughout the constituency. That was a major benefit in terms of encouraging children to exercise on a more frequent basis.

Mr. White rightly stated that dealing with this problem cannot all be down to personal responsibility but I am a firm believer in personal responsibility and taking responsibilities for our own decisions. Whether it be from a health or financial perspective one cannot abdicate one's responsibility in totality. One must take responsibility for oneself and one's own actions. Otherwise, where would we draw the line?

As legislators it behoves us to consider introducing legislation. There was news in the media this week about a sugar tax and banning the advertising of unhealthy food. Those are issues we can examine but the witnesses might respond on some of the points I raised or if there is anything else they believe we should be doing they should bring it to our attention.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I join with the Chairman in welcoming the representatives from the Nutrition and Health Foundation the Institute of Leisure and Amenity Management, and Mr. White. They are all very welcome. I do not have many questions to ask.

There is no question but that Mr. Trevor White's contribution has challenged us. That merits some further consideration and, no pun intended, we need to chew on it. It is not a bad thing to be challenged. I welcome that. The representatives should not think, in terms of any of their cases, that by not asking questions we are not interested. We are deeply interested in all they have outlined.

I welcome the Nutritional Health Foundation's representative, Dr. Cullen. I will not address the issues Mr. White raised regarding the composition of the foundation or the way one accesses it. However, I note that in the circulated pre-meeting text there is a significant food and beverage industry representation. There is a 2:3 ratio from the point of view of the food and beverage industry to non-industry partners. I have a minor concern about the presentation, although I am encouraged by several of the points in it.

Reference was made to prioritisation. It is all to do with perception. The NHF chooses two groups to prioritise in the context of childhood obesity - pregnant women and children. It helps to make the point that was made in the contrary presentation by Mr. White because it is important that the food and beverage industry have priority consideration in the matters under address. It does place the priority responsibility on the individual. We are all challenged by an array of different pressures in modern life choices. Time is a big factor and affordability is another issue. This does not apply only to the choices we make about the foodstuffs we purchase in supermarkets or convenience stores.

It is not an issue for me whether research and development incentives for the industry are the carrot or the stick but incentives must be put in place for the industry to make better choices in the component parts of their products. Are there alternatives to the ingredients used in the manufacture of products aimed at the food shelves of our supermarkets? Can we examine the notion of encouraging research and development into alternative ingredients that are less threatening to our general health, with a particular focus on obesity in young people?

Deputy Dowds referred to the sugar tax proposal. It is important that everything is measured. It is not that sugar is bad for people. Sugar creates energy and is an essential ingredient in many products. The issue is the excessive employment of sugar in many products that are currently available, and there needs to be an identification of what is normal, reasonable or acceptable and where the excess needs to be confronted. That is where we should focus some attention.

I know from my role as a Dáil Deputy over the past number of years - I am not attacking the leisure industry - that a fact of life in these ever-straitened economic times is that more and more families cannot afford access to leisure facilities and activities because of prohibitive costs. Families in my constituency have made a conscious effort to encourage their young children's participation in a variety of physical activities, and I acknowledge there are cheap or no-cost alternatives, but it is difficult in these times when some children can enjoy access to certain activities and others cannot. This contributes to the sense of inequality in our society. As Dr. Cullen pointed out, it leads to a similar choice to that between a healthy but costly food option and an unhealthy but less expensive option. The expense issue features not only in our food choices but in all other choices life offers and, for many, these cannot be offered because they cannot afford them.

10:55 am

Photo of Catherine ByrneCatherine Byrne (Dublin South Central, Fine Gael)
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I thank all those who made presentations. We have debated this issue over the past few months. When I was growing up, I did not know anybody on my road who was obese. Everybody skipped and played beds, rounders and football. On Hallowe'en, I saw the largest number of children on my street over the past number of weeks as they knocked on doors with their baskets. It would have been an interesting exercise to have pricked the finger of every child in school the following day to see how much their sugar levels had increased. Two 14-year-old lads knocked on my door and said they only wanted money or sweets and that anything else would not be acceptable. I love a bar of chocolate. I bought a tape in the chemist that one puts around one's waist and found that I am obese. I was not obese in my late teens or early 20s but when I started to have children, for some strange reason, I became obese. Lifestyle is an issue and I agree with Deputies Ó Caoláin and Troy that the amount people have in their pockets is also an issue.

We had a group before the committee a few weeks ago talking about healthy food, and I was struck by a number of remarks they made. They said more children in poorer areas are obese because they eat cheaper cuts of meat and eat fish fingers rather than fish. If I go into my local supermarket to buy fish, I am always struck by the fact that one piece of fish costs more than the hourly minimum wage. As we are an island nation, we must do something to rectify this. Parents - I include myself in this - fill supermarket baskets, not children, and there is a significant responsibility on them. It is no harm to put in a bar of chocolate now and again but we need to realise that what people are putting in does not reflect what children should eat. I believe a little of everything is good for people. I do not drink or smoke and nothing is harmful if it is consumed in moderation. I have never met a child who plays camogie where I live. The kids I know play football in the local GAA club on Saturdays and they kick around a ball at the local youth club. I think, therefore, that Mr. White and I are talking about a different range of people.

If I had a wish come true tomorrow and the State had loads of money, I would provide funding for schools to make sure every child has a one-hour physical education lesson every day with a professionally trained PE teacher and not with the girl who is trying to teach them English, Irish and mathematics. If we are serious about tackling childhood obesity, we need to start putting primary school children into gymnasiums where professionals can put them through rigorous exercises. I do not mean boot camps, but that is where we should begin. Many children where I live are delighted when their parents take them for a walk along the canal or to the local park, but most parents sit in front of the television or an iPad or something else that prevents them from taking time out of their busy days to sit with their children for ten minutes. Like most parents, I work, and I feel that over the past 13 years that I have been in politics, I have missed out on a great deal of the lives of my two youngest girls.

I thank the representatives for their interesting presentations, but the number one priority is to put children into gymnasiums in school. I know many families who cannot afford to go swimming in the local pool in Ballyfermot because they do not have the money.

Photo of Robert DowdsRobert Dowds (Dublin Mid West, Labour)
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I thank all the witnesses for their presentations.

I thank Mr. White for reminding me about my remarks on advertising and children and, in a sense, prodding me to pursue the matter further. Deputy Catherine Byrne has touched on an aspect of the issue that is critical where children are concerned. I spent many years as a teacher and noticed a change in children’s approach to life. It now tends to be much more sedentary than it was, even to the extent they would come up to me in the schoolyard to tell me they were bored and ask what they should do next. When I was a child, I do not remember asking that question. How can we encourage a more active lifestyle among children and their parents? Some solutions would be basic such as walking to school and so forth.

Is it the case that good wholesome food is more expensive than processed foodstuffs which are promoted so much? My suspicion is that it is to a degree. There is a job of work for those with the authority to do so, including ourselves, to do more to indicate to children what is an appropriate amount of food to consume. I appreciate that the food pyramid is to be found in most classrooms, but it might need to be developed more in pointing out what would be a suitable breakfast, lunch and evening meal. Similar presentations should be made available for adults.

11:05 am

Dr. Muireann Cullen:

On the cost of food, it needs to be brought back to basics. From a nutrition point of view, fresher food produce can be more expensive. As there are certainly many specials available in supermarkets, it is a question of looking out for them. Tinned and frozen foods can be as, or even more, nutritious than unprocessed food because they have not been left lying degenerating on the supermarket shelf.

As I said, we have cases in which we have had intervention in the GP setting to show mothers how uncomplicated it is to have a healthier diet, as well as encouraging more physical activity which will also benefit the future health of their children. However, I agree we need to have greater intervention at school level, with healthy eating guidelines and physical activity, which need to become compulsory. I agree with Deputy Catherine Byrne on the need for physical education every day for one hour, particularly considering our children need 60 minutes of moderate to vigorous physical activity every day. As we know we are not reaching that target, school is an important environment in which to exert influence in this regard.

The home environment is also key when it comes to food consumption choices, how often they are consumed and cooked, etc. We need to bring into home economics in school aspects such as the enjoyment of food and balanced diets. Unfortunately, it is difficult to be prescriptive with children when it comes to the food pyramid because they grow at different rates. However, there are suggested portion sizes for the different age groups. A colleague of mine has told me that when her kids tell her they are hungry, she tells them to have a piece of fruit. If they say no to the fruit, she knows they are not really hungry.

Photo of Jerry ButtimerJerry Buttimer (Cork South Central, Fine Gael)
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Does that indicate the difficulty we encounter that we see fruit as being the non-sexy choice when it should be the first choice?

Dr. Muireann Cullen:

Healthy eating should be as natural as anything physical. We wash our teeth twice a day. Likewise, healthy eating should be as natural to us. Part of the difficulty is that healthy eating, as well as physical activity, is not considered sexy. My colleagues from the Institute of Leisure and Amenity Management know much more about this, but the body image concern comes into play when girls move into their teens. Sporty girls are seen as more masculine. We need to dispel this and create a positive movement around physical activity. Walking, for example, presents a great opportunity for families to spend time together away from the pressures of school and work.

I am very passionate about intervention. The food industry has a role to play. I am not here to defend the industry because the organisation I am in is a multi-stakeholder one. I am sure, however, that Food and Drink Industry Ireland would be more than willing to have a chat with the Deputy. There is work being done with regard to the reformulation of products. Absolutely anything and everything should be encouraged to provide healthier options. It is an area that is being worked on, but more needs to be done. Every sector has a responsibility in this regard.

Mr. Trevor White:

I admit to being depressed by the committee’s response to this session. I have stressed repeatedly that the entire debate is being framed in terms of personal responsibility. I thought I had made a sincere plea and that the points I had made were relatively clear. I wanted to stress that it was not simply a question of personal responsibility, yet every remark made by committee members has been around the importance of personal responsibility.

Photo of Jerry ButtimerJerry Buttimer (Cork South Central, Fine Gael)
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Personal responsibility-----

Mr. Trevor White:

To reiterate, I have not denied-----

Photo of Jerry ButtimerJerry Buttimer (Cork South Central, Fine Gael)
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Hold on, Mr. White. Many Members took part in “Operation Transformation”. For us, it involved a collective and personal decision about our own eating habits. If someone does not take ownership of a problem, how can we arrive at a solution to it? I accept Mr. White’s point that it is not all about personal responsibility, but how we can move forward without people taking personal responsibility for their eating habits?

Mr. Trevor White:

I accept your point, which I made this morning, namely, that personal responsibility is an essential component of the solution to this problem. No one in this room denies that. However, it is singularly depressing that we are having a conversation about obesity in which it is framed as being almost exclusively an issue of personal responsibility.

Photo of Jerry ButtimerJerry Buttimer (Cork South Central, Fine Gael)
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No, it is not. I think Mr. White is mistaken. To be fair to committee members, they did not do that this morning. They have said there are other issues to be taken into consideration. Mr. White is doing them a disservice by claiming they are focusing solely on the issue of personal responsibility when they are not.

Mr. Trevor White:

I remind the Chairman that we have the second highest level of childhood obesity in Europe and one of the highest in the world. We are not talking about a delicate issue; rather, we are talking about a public health crisis.

Photo of Jerry ButtimerJerry Buttimer (Cork South Central, Fine Gael)
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That is why it is a priority issue for the committee.

Mr. Trevor White:

Good. I am pleased and encouraged to hear that.

I will respond to the Deputies' observations. I agree absolutely with Deputy Ó Caoláin about the importance of personal responsibility. Unfortunately, the trouble is that it is not a level playing field. To illustrate that point I cite research by a woman called Joanna Blythman, arguably the leading investigative journalist on the politics of food production in the United Kingdom. She discovered recently that for every pound the British Government spends on promoting the consumption of fruit and vegetables, healthy eating and stretching the legs, the top ten food and drink brands spend £99. In other words, every time a person is encouraged to take a walk or eat an apple he will hear 99 messages exhorting him to reach for the heavily sugared water or junk food. That is not a level playing field. Industry has completely skewed the terms of the debate. It is difficult because people are being robbed of individual liberty in this situation and it is deeply depressing. It is incumbent upon the committee members as legislators to acknowledge the scale of the problem and address it. That should not be done through wishy-washy well-meaning drivel such as telling people to go for a run. We are at crisis point, well beyond the wishy-washy stuff. We have an obligation to address this problem as a society. If we do not do so, the cost of treating these diseases will be astronomical, such that future generations will look back on us with embarrassment and disgust because we did not address this problem.

11:15 am

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Part of an exercise such as this involves Mr. White being listened to, but he should do the other participants the courtesy of listening in return. He has demonstrated to me by his remarks that he has not listened to one word we have said. Given the seriousness of this issue, I find it most disappointing that Mr. White has not taken the time to note the points we have made. Contrary to what he has endeavoured to make the record of my participation, I made no reference to personal responsibility. In fact, I highlighted the fact that the priorities of the body Mr. White has set off this morning to attack were focused on the responsibility to pregnant women and children. My focus was in respect of the food and beverage sector. I made it clear that there needs to be an address of the industry. I mooted the idea of research and development incentives and indicated that I had no issue about whether carrot or stick was employed. I also referred to what is sometimes termed a sugar tax, but I was referring to excess. Those are the points I made. The point I made subsequently related to the affordability of access to various activities. As a Dáil representative of many years, I am aware that this is a serious situation for families. The families I represent find it difficult to cope in these times of austerity. At the least, Mr. White should do me the courtesy of addressing or recognising what I have said. I welcomed his contribution and I said it was challenging. In reflecting on what I have said, I would prefer if he would do so accurately.

Mr. Trevor White:

I accept the remarks of Deputy Ó Caoláin. I was referring specifically to the mention of pregnant women in my response. I should have addressed the committee more collectively as a group of respondents, and for this I apologise.

Photo of Jerry ButtimerJerry Buttimer (Cork South Central, Fine Gael)
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I wish to put one question to Mr. White based on the previous themes. He listened to Ms Moloney's presentation and her example. Let us consider his comments about commands to exercise being drivel. The 12-week weight loss programme to which Ms Moloney referred is an example of what can be done. Admittedly, it is not only a question of 12 weeks; it involves a lifetime commitment to change. Anyway, let us consider the example of "Operation Transformation" on television or what safefood is trying to achieve. This is about a lifetime change in terms of behaviour and attitudes. It is not simply drivel. Does Mr. White not accept that?

Mr. Trevor White:

My point is that it is too late to be tinkering around the edges. We have a public health crisis of epic proportions and, as a society, our heads are in the sand. We are not addressing this problem. Unless fiscal measures are introduced by the Government, unless the Government acknowledges its responsibility and unless industry is stood up to and given the short shrift it deserves at this point, this will probably get worse and worse.

Ms Christine Moloney:

I welcome the fact that Deputy Ó Caoláin referred to the big issue of affordability, mainly because this is our primary concern as well. Our aim is to make our centres accessible but prohibitive costs come in the form of VAT and energy prices, which make it difficult for us to provide services. Many of our facilities are not profit-making organisations but they are certainly self-financing and the finances they make go back into providing the services. Legislators have the opportunity to remove these barriers and to provide our facilities free to people who are on the breadline. Currently our facilities provide free swimming to children under five years old. It used to be free for those under three years old but we increased the limit to five years to encourage families to come.

Society has created a significant problem by preventing our children from engaging in natural play because parents' primary concern is safety. As a society we need to find some way around this barrier, and it must be in a safe environment.

Photo of Jerry ButtimerJerry Buttimer (Cork South Central, Fine Gael)
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Is the issue of safety a concern for your industry? Are insurance premiums and litigation of concern?

Ms Christine Moloney:

It has become a greater issue since the recession than it was in years previously. Many of the claims come from areas of lower demographics. These costs are in place but the committee members, as legislators, have the chance to make a decision to provide subventions through health promotion units across the country. The legislators have the opportunity to use us.

A schools physical education programme is in place and we should ensure our children are active in the educational environment, but the issue is that schools do not have the money to send the children to learn to swim; the parents are paying for it. Parents are having to fork out constantly to give their children opportunities. Because of peer pressure, the children cannot be told they are not going swimming. This affects us as a society as well.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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It is another aspect of everything we have been addressing in recent times, because not all children in every class are getting there. I know of situations in which some children are left behind while the class goes swimming.

Ms Christine Moloney:

Absolutely.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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It is absolutely awful, because this contributes to further problems. Let there be no mistake. These are the early seeds of mental health issues in terms of confidence and all the other things that will have an impact on young people growing up. It is absolutely awful.

Ms Christine Moloney:

These are our future adults, so it is a vast problem if we are not planting the right seeds. It is a big problem for the future.

Deputy Catherine Byrne referred to the waistband initiative launched by safefood. This was operated through chemists. Why was it not launched in all of the leisure centres throughout the country? People could have come to get their waistbands measured in our facilities. That would have been the natural environment, not the chemist's store. We were totally forgotten about in that regard.

Photo of Jerry ButtimerJerry Buttimer (Cork South Central, Fine Gael)
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Has ILAM costed its proposals on VAT and benefit-in-kind in terms of the implications for the Exchequer? Has it negotiated any decision with health insurers?

Ms Christine Moloney:

Mr. Walsh is better able to answer those questions.

Mr. Barry Walsh:

We have not done so. At the moment we do not have the resources to do the research ourselves. ILAM has a small administrative team. However, as an industry we need to fight our corner and put ourselves forward in this area.

We certainly saw in our own facilities that when benefit in kind was introduced, the fall-off in company and corporate memberships was phenomenal. Companies then only offered a €250 contribution to their employees. The corporate well-being programmes have almost been eradicated by the introduction of benefit in kind on membership.

Deputy Ó Caoláin's point about children being left behind definitely applies to certain socioeconomic groups. Swimming costs, in particular, are prohibitive but a lot of our facilities, both public and private, are under enormous financial pressure. As an industry, we cannot afford to allow free access to our facilities but we are here today to try to find solutions. I find it slightly ironic that the same socioeconomic groups to which we are referring have free access to GP care through the medical card scheme. A cost benefit analysis should be done. We are on the proactive side of tackling obesity, while the health care system is on the reactive side. We are waiting for people to become obese or overweight and then giving them free access to medical care. Perhaps we could develop a solution whereby we provide free access to leisure facilities through a system similar to the GMS, whereby the providers are given funding for facilitating those from certain socioeconomic groups.

11:25 am

Photo of Jerry ButtimerJerry Buttimer (Cork South Central, Fine Gael)
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Could Mr. Walsh see his members playing a role in the primary care system in certain localities?

Mr. Barry Walsh:

Most definitely, yes. By its very nature, the term "primary" suggests preventive although I do not believe the current primary care model is actually thus. It is a reactive solution to a societal issue. The medical system is there for when something goes wrong rather than to prevent something from going wrong. The collective submissions to the committee from various agencies and bodies have tended to focus on reactive solutions. The medical professions provide the research and diagnosis and then offer solutions. The intervention model is what our members are involved in, collectively.

Photo of Jerry ButtimerJerry Buttimer (Cork South Central, Fine Gael)
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Has Leisure World's project weight-loss model been replicated anywhere else? I take Mr. White's point regarding responsibility but this is an example of the leisure industry, in partnership with sports practitioners, being proactive. Perhaps it could be widened out to involve the food and beverage industries, which have an enormous role to play. Has the leisure industry engaged with the food and beverage industry, the HSE or other health professionals on that project?

Ms Christine Mooney:

The main agency we felt we needed on board, in terms of endorsement, was the HSE. However, it took us a long time to get the HSE involved in the project. It took almost 12 months of knocking on the door of the HSE, which was very frustrating. The HSE is the key agency involved in health promotion in this country but it did not immediately see the benefit of endorsing this project. After the pilot scheme we approached the HSE again and showed it our results and only then did the executive come on board. It endorsed the project and is now involved in taking it to the wider county, in conjunction with us and the sports partnership. If that model continues to produce evidence of success it will be taken across the country. That is our vision for the project. It is a slow process but I would like to think that in 12 months time we will have a nationwide project weight loss.

Photo of Jerry ButtimerJerry Buttimer (Cork South Central, Fine Gael)
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I wish to ask Dr. Cullen a question in the context of her presentation -----

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Excuse me, Chairman, but I must leave now. I want to thank all of the panellists who attended and wish them well.

Photo of Jerry ButtimerJerry Buttimer (Cork South Central, Fine Gael)
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In the context of the composition of the NHF, is it fair to suggest that the stakeholders have too much of a say?

Dr. Muireann Cullen:

We have more non-industry members at the moment than industry members. I would like more industry members because that means more funding for the foundation. It is important to point out that anything we do must be agreed by all members of the foundation. The industry puts up the money and we are upfront about that and publish details on our website about who is funding the foundation. At the end of the day, it is about co-operation and working together so anything we do is by agreement with our industry and non-industry members.

Photo of Jerry ButtimerJerry Buttimer (Cork South Central, Fine Gael)
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I thank the witnesses for attending and for their presentations. It was a very interesting meeting. I assure witnesses that obesity is a priority issue for this committee. Ultimately it is a matter for Government but we will formulate our report, through Deputy Fitzpatrick, who is our rapporteur, based on all of our meetings on this subject. Today is our final hearing on obesity and once again, I thank the witnesses for appearing before us.

The joint committee adjourned at 12.05 p.m. until 4.30 p.m. on Tuesday, 20 November 2012.