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.