Oireachtas Joint and Select Committees
Thursday, 14 February 2013
Joint Oireachtas Committee on Health and Children
Tackling Obesity: Discussion with Operation Transformation
I remind members to please turn off mobile telephones as they interfere with the recording and broadcasting equipment. Apologies have been received from Deputies Regina Doherty and Eamonn Maloney and Senator Imelda Henry.
I welcome the team from RTE's "Operation Transformation", Dr. Eva Orsmond, Dr. Eddie Murphy and Mr. Karl Henry. In particular I welcome the five leaders, Ms Charlotte O'Connell, Mr. Gavin Walker, Mr. Gregg Starr, Ms Monica Percy and Ms Deirdre Halford. I also welcome from the production crew Ms Niamh Bradley, Mr. Jack Britton, Mr. Andy Malone and Ms Brighid Breathnach. I thank committee members for attending. I wish everybody a happy Valentine's day and I hope the love in the room is transmitted throughout the country. I also hope the love remains within the room for the duration of the meeting.
Childhood obesity is part of the committee's work programme for 2012 and 2013 and we are very conscious there is a consequence to being overweight and we must be aware of the risk to our health. I pay tribute to the five leaders who have, in the full public glare of the nation, done Trojan work since they began the campaign. They are a credit to themselves and their families. They are fantastic role models and have shown that awareness and recognition pays dividends. I thank the three experts for coming before the committee.
Before we begin I wish to draw to the attention of witnesses the fact that they are protected by absolute privilege in respect of their evidence to the committee. However, if they are directed by the committee to cease giving evidence on a particular matter and they continue to do so, they are entitled thereafter only to a qualified privilege in respect of their evidence. Witnesses 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 a way as to make him, her or it identifiable.
I remind members of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against any person outside the Houses or an official, either by name or in such a way as to make him or her identifiable. I call on Dr. Eddie Murphy to make his opening remarks.
Dr. Eddie Murphy:
For the past six years we have asked the people of Ireland to follow our leaders on "Operation Transformation" to achieve a healthy weight, increase their physical activity, and improve the quality and length of their lives. We are grateful our current leaders, Monica, Deirdre, Charlotte, Gregg and Gavin, have joined us today. The committee has heard about the problems and "Operation Transformation" is here to identify some solutions.
We believe it is increasingly difficult to be a normal-weight child or adult in Ireland. On behalf of our viewers we would like the committee to consider seven simple changes which can be made to make it more likely for the next generation to have a better chance of avoiding obesity and the damage it does to their bodies and minds. Our presentation is based on the science of psychology, medicine and sport.
Dr. Eva Orsmond:
A few years ago we weighed children in primary schools. We wanted to highlight the fact that parents did not know what their children should weigh. We also found out many adults did not know their own weight or what is a healthy weight. The weighing scales must become part of our lives again. We need to become aware of our weight and that of our children. We recommend that children are weighed at least once a year at school. Every time one attends one's GP or a hospital one should get on the scales. This will not only increase awareness of what is a healthy weight, it will also increase the important awareness of the link between excess weight and chronic illness.
Weighing a patient also creates an opportunity for an early intervention before the problem become a chronic illness.
If we start now, hopefully we can avoid the situation in which Aaron found himself. Let us have a look at the video.
Dr. Eva Orsmond:
If we had this basic level of intervention, would Aaron be featured in our show this year? A 12 year old from Tallaght, he weighed 21 stone when his mother, who was worried about his weight, brought him to "Operation Transformation". He is a brave young man who is now trying to save his life from a chronic illness. We have helped him to lose 3 stone, but his journey to his optimum health has only started.
It is time that we started recording our children's weight. Everyone attending a general practitioner, GP, or hospital appointment should also be weighed. If all education and health institutions made an effort together, we would raise awareness of what a healthy weight was and prevent children like Aaron from ending up in his situation.
Mr. Karl Henry:
When it comes to change, knowledge is power. "Operation Transformation" is the largest health show that this country has ever seen. A major remit for what we do is providing awareness and knowledge where they are needed the most. If we can get children moving at primary level, the chances are that they will stay healthy, active and fit through secondary and third levels and, more importantly, for life.
Members saw what we do on the screen. It is the "Step It Up" campaign, a simple, clear and effective message - 15,000 steps per day. We provide a unit of measurement, get teachers and parents involved and create awareness across the board. As members saw in the clip, in under four weeks children went from taking 7,000 steps per day to more than 30,000 steps. The benefits over those four weeks are great, but imagine them on a lifelong basis. More importantly, the clip showed how receptive and empowered people were when given the right knowledge and shown the way. The nation wants to change. The clip showed that it can and that teachers, parents and children want to make these changes, but do not know how.
The "Step It Up" campaign is such a simple message. It delivers results, as shown in the footage. Aaron was taking 2,000 to 3,000 steps per day before the campaign started. After four weeks, he is taking nearly 30,000 steps. The campaign creates habits that will last for life. We can get our children active using a simple message and a simple tool. We have seen the effects of these tools.
The clip shows how much people want to change, but the ball is in the committee members' court. They must provide the message and show them the way. "Operation Transformation" has done that in a four-week timeframe. We have proven results. Consider the benefits over four weeks and multiply them over the course of one, two or ten years or life.
If we can get children active in school and show them the way with a simple, clear and effective message, we believe, and research shows, that an increasing number of children will stay active on a lifelong basis.
Dr. Eddie Murphy:
We come now to our third solution, namely, fruit at the checkout. We are grateful that supermarkets support "Operation Transformation" every year by making it easier for people to find healthier options when choosing their food. As a psychologist, I know that having healthy prompts around shops supports people in making healthier choices. How we lay out the world around us indicates our priority. One of the most valued spaces in supermarkets is at the checkout. We do not want to remove people's right to choose. We just want to nudge them in the right way so that they make healthier choices.
Currently, the priority at most checkouts is displaying sweets, chocolates, crisps and sugary drinks. We must get our priorities right if we are to tackle the obesity epidemic. A simple, powerful message is to swap sweets for fruit. This is something that has come from here. It would not cost anything and would give people, including parents, a chance as a country to say that they would prefer it if healthier choices were given the best place in their shops and if each checkout was switched from sweets to fruit.
That is our third step. We will now move on to our fourth step.
Dr. Eva Orsmond:
Every year on "Operation Transformation" we discover that our leaders know very little about food and that their cooking skills are either basic or non-existent. A lack of food knowledge and poor cooking skills leads to unhealthy choices, including reliance on takeaways and pre-prepared foods, which are often loaded with sugar, high in fats and saturated with salts. We need to return to the basics. We need to teach people how to cook and about the basics of food. We believe that food education should become part of school education. Every child should know the basics of cooking and the difference between healthy and unhealthy food. It would be great if on leaving the education system every child knew how to cook a least five basic main meals. This should not be optional or examination-controlled. It should be seen as education in basic life skills which every child should know.
Dr. Karl Henry:
Every year on "Operation Transformation" we take a national health issue and make it fun. While the reaction of Members today to the audiovisual presentations has been to laugh and smile obesity is a serious national problem.
The next point on our plan is entitled "Fit at School, Fit for Life". We know that if we can get children active while in primary education the chances are they will stay fit for life. The current recommendation on physical education is one hour per week. We know that many children are not even getting this.
Members saw the hero-teacher concept in the video presentation. Our concept this year is recognising those in schools who make a difference, who go above and beyond the call of duty and over and beyond their required hours to get their pupils moving and healthy. Every child in Ireland does not, unfortunately, have access to a hero teacher. We do not believe they should. What we are promoting is one additional hour of physical education on a weekly basis for the 3,300 national schools across Ireland, using 100 primary school physical education teachers. We believe this would have a lasting affect at a health and national level. More important, if we can get primary school pupils moving the chances they will continue to do so in second and third level.
We have a huge problem in secondary level schools because as children move through the curriculum physical education becomes less important. I ask Members to think back to the time of their leaving certificate examination. If at that time they had been offered 20 bonus points if they passed a particular level on a bleep test, how would they have reacted? Would they have taken the opportunity to get those points, or not? Professor Niall Moyna of Dublin City University, DCU, believes that awarding points for fitness in the secondary education system will ensure physical education remains important throughout that system. Students at leaving certificate level could be offered bonus points if they pass a particular level in a bleep test.
As a nation, we once had a problem with honours level mathematics. This was addressed by way of giving extra points to those students who took honours mathematics. We believe the same incentive should be put in place for physical education. On last week's show, we carried out a bleep test on a fourth year class in Athlone, the results of which were shocking. The students' fitness levels did not come anywhere near the EU recommendation. We offered the incentive of €1,000 if they could pass the test eight weeks later and they did. The results were above the EU recommendation. The return on this investment - a bleep test, for which a CD and CD player is required - at school level, which is one of the most stressful times in anyone's life, will be healthier students whose results will be better. It will also prolong the physical education system. Chances are that students at third level will be active if they were active at leaving certificate level.
We believe points for fitness is a key, simple and effective message. From an exercise perspective, the Step-it-Up campaign and Points for Fitness, are simple, key tools, which are cost effective and easy to implement and will deliver real results. We have shown through the audiovisual presentations what can happen. We have shown the results. The ball is now in the committee's court. We hope it will follow.
Dr. Eddie Murphy:
This takes us to our sixth from seven points, the Count Me In campaign. We began this three years ago when we saw how it was working in America. It is very simple. Beside the price on a menu one can see the calories in an item. With food chains, it gives people the chance to make informed decisions about what they are buying. Right now, somebody is buying a muffin but that person has no idea that the item contains a quarter of their recommended food intake for the day.
The Food Safety Authority has surveyed people and those in the industry, and 96% of people wanted calorie posting. That is how clear it is. The Food Safety Authority promised action on this 12 months ago and we are still waiting. There is talk of a soft approach, where chains can make their own interpretation of calorie posting. If we are to give Irish people a chance by offering clear and consistent information, we need legislation instructing food chains on how to display calories. When a person places an order, he or she should be able to clearly see how many calories will be consumed. We must put calorie information up with the point of sale.
Dr. Eva Orsmond:
Type 2 diabetes, high cholesterol, high blood pressure and numerous chronic diseases are directly related to our lifestyle. A recent study at Newcastle University proved that rapid weight loss can reverse type 2 diabetes. On "Operation Transformation" last year we got a volunteer to undergo the same rapid weight loss treatment and before the series was over, he was able to come off his medication. This year, we have seen significant improvement in the health of all our leaders. Both Mr. Walker and Mr. Starr had their cholesterol levels drop from dangerously unhealthy to healthy in only four weeks. The aim was to demonstrate to viewers how fast our bodies can respond to a healthy lifestyle change.
We have a culture of relying on medication for every ailment and our doctors are often too quick to prescribe medication that soon becomes a cocktail of drugs for life. More effort must be made to get patients to lose weight and improve their health without the need for medication. This approach to treatment will significantly reduce the amount of prescription medication and will save millions in the health budget. Doctors lack nutritional education and many of our dieticians and nutritionists are misinformed as the guidelines are totally outdated. As a result, losing weight and changing lifestyle is almost impossible. We must return to the basics and treat the cause, not the symptom.
Dr. Eddie Murphy:
We are nearly at the conclusion. People have personal responsibility to look after their own weight and fitness but doing that now is a bigger struggle than ever before. We must give people the tools to look after themselves and information to make healthy choices. Legislation must give the people of Ireland a chance. Our five leaders have volunteered a role to a healthier future and have offered a path for others to follow. When this show ends, their struggle will continue.
Dr. Eddie Murphy:
We are in the business of change and the committee members are also in the business of change. If our society does not change, it will falter. When a group of politicians followed the plan, it was inspirational, but as many people may have learned, it can be hard to keep the process going when the show finishes. Even with knowledge and awareness, it can be very difficult in the current environment to maintain a healthy weight, and to negotiate that environment, we need clear messages. We appreciate that those messages may have an impact on some commercial interests but these Houses look to protect the citizens of Ireland. We do not have to be the fattest people in Europe and we do not want to have to say that on "Operation Transformation" in five years. Knowledge is the power to change and all we want is to give our people a chance.
I thank the witnesses for coming here and giving an excellent presentation. They might excuse the pun when I say it has certainly given us food for thought on what legislators must do. There is a real issue that will require Departments working together, with the Department of Education and Skills having a serious role to play. Perhaps the same presentation can be given to the Joint Committee on Education and Social Protection.
I do not have any questions. I thank the delegation for an informative presentation. Given the severity of the obesity problem in Ireland it behoves all of us, regardless of political party or none, to work together to address it.
Go raibh maith agat. I welcome the delegation. This has been an exceptionally interesting morning for the committee. The delegation has made one of the most compelling cases that any of us have ever heard. I congratulate each of the five leaders. They have not spoken yet but they have spoken to us in other ways to each and every one of us.
Many of us here, myself included, could be where the participants are. We must build awareness of the appropriate weight for anyone of us. That is one of the lessons that came out of the message this morning, particularly for parents. The case of the mother and the young boy of 12 years is a little more obvious than many cases that would equally merit address. We must pay more than lip service to the problem. We must examine what we can do and not only in terms of encouragement which is important. We must explore the possibility of legislative changes but it will take more than this committee to do so. It will require an across-the-board holistic address comprising the Department of Health, Department of Education and Skills, safefood Ireland, who have an important role to play, the HSE plus the contribution made by the show. It is important to continue improving when the show wraps. It is a little like the pre conversation that we had before the group arrived, and Dr. Murphy made the point, the participants are in the business of change. None of us are more aware of that than I having looked at the faces of those who appeared on the current programme. When I look around at the committee members this morning there are only two of us who could possibly have signed up three years ago for the "Count Me In" programme. I was one of them and I had an opportunity to appear briefly on the group's previous television presentation. Change is very much a part of political life too.
One of the things that the committee could leave as its legacy is a little bit of leadership, like in political life, and what can be done to follow on the example given when the programme concludes. It would be terrible to lose good habits learned from the programme. Many of those people from political life who participated in the video presentation made by the group would acknowledge that the best practice that they had adopted over the period started to dissipate as time moved on. Old habits easily return. We need to encourage people to continue the good habits learned. A seven point plan was provided by Dr. Murphy, Dr. Orsmond and Mr. Henry and I thank them for their powerful presentation. We must recognise the common denominator between their plan and the safefood recommendations. There is much that we can do but it must be a collaborative job of work. I thank the group again. The five participants have been powerfully courageous and they have done us all a great service. I wish them good luck in the future.
I thank the delegation for the presentation. I wish to express particular thanks to the team leaders who are Ms Charlotte O'Connell, Mr. Gavin Walker, Ms Deirdre Halford, Mr. Gregg Starr and Ms Monica Percy. I also wish to thank the boy named Aaron. With my children's rights background I am particularly passionate about childhood obesity. His mother and him were very honest. The challenge of childhood obesity is being faced in many households in Ireland. The presentation is a wake-up call for all of us. That is why I welcome the seven point plan outlined to us today.
I welcome the approach taken by "Operation Transformation". Unlike its contemporary programmes in the UK and US which have winners and are so competitive, "Operation Transformation" is about lifestyle changes and our health. The honesty of the leaders in facing some of their life issues in a public sphere gives heart to the rest of us and encourages us to face up to our own challenges. We can never underestimate the power of handling issues in a non-judgemental manner.
I welcome the "Step it Up" campaign. The best bit for me was the pride in the young people's faces as they sat in their classroom and declared the number of steps each had taken. It shows the possibility and potential of the campaign. The project can build the self-esteem of young people and they learn that they can be part of their own solution. Often we look at children as problems rather than leaders and I welcome that development. I also welcome the involvement of parents.
I agree with the delegation's promotion of having fruit at checkouts and healthy prompts which we all know about. Recently I spoke to transition year students participating in a cross-community project in Howth and Sutton. During the workshop we had a coffee break and they surprised me by producing fruit cups and a plate of biscuits. The fruit cups were in plastic cups and two-thirds of the boys and girls chose them to eat. It was amazing to see how easily a healthy option can be made available and incorporated into their lives. I have also been to a school located in a disadvantaged area which has a breakfast club. The school realised that the children's lunches were bad. A new initiative was prompted when a child was found standing over a bin eating dry pot noodles. I am not a pot noodle fan but I found the idea of eating dry pot noodles disconcerting. The teacher decided to deal with the matter. The school invited the parents in with their children and informed them about the types of lunches they could make. That child now makes her own tuna wrap for school.
That brings me to another issue. There are figures which state that one in four or five children, depending on which research one reads, go to school hungry. All of us think that is due to austerity and poverty created by the recession. In fact the reason many of those children go to school hungry is due to the wherewithal of their parents and it is not always a monetary issue. Clearly there are some poverty issues. It is also a matter of having the right foods in a household to allow children eat a breakfast in the morning and therefore are better prepared for school.
I welcome the "Count Me In" initiative and when I visited New York last summer it influenced my eating. Being able to see the calorie content does have a direct effect on the food choices that one makes. It encourages us to choose a healthier option.
The programme has given the Irish nation a challenge. It has given politicians an even greater challenge because me must see how we can implement the seven step plan and what role we can play. I thank the delegation for its leadership.
I welcome the experts Dr. Murphy, Dr. Orsmond and Mr. Henry. I also congratulate the five participants for doing such a fantastic job. When I saw them earlier I could not believe that they were the five participants because they look fantastic. They have put in an unbelievable effort. As a sportsperson I realise how hard it is to keep oneself fit and to exercise right. I have nothing but admiration for the five participants. The most important thing is that they realised that they had a problem and wanted to solve it. The participants trusted the three experts and I have learned a lot from them. I thought that I knew a lot about food and drink but now I realise that I did not. I have learned a lot from the experts. I would be the first person to put my hand up to say that I admire all of them.
My philosophy is that exercise should not be a chore but a habit. Every morning when I leave my house my wife gives me my sports bag and if I get an opportunity during the day I do some exercise.
I mean that every opportunity one gets is unbelievable. Since "Operation Transformation" was broadcast there has been an increase in people taking up exercise. As I drive home to Dundalk this evening I will see an incredible number of people outside walking, running and taking their dogs for a walk. Any type of exercise is beneficial. One does not have to just do walking. One can cycle, play tennis or any other sport. It is a matter of getting out and doing some exercise. The programme has encouraged people to get out and exercise.
The obesity level here has risen dramatically in the past 20 years. In 1990 only one in every ten adults was obese but in 2013 the figure is one in four which is a shocking statistic. In the same period obesity in women has increased from 13% to 21%. Data also reveals that there has been a significant increase in teenage obesity since 1990 with an eightfold increase in males and a twofold increase in females.
We mentioned type 2 diabetes, hearts, strokes and so forth. We have to realise that we must get out and exercise. Years ago, if somebody was seen exercising people would say: "Look at that eejit". Now, however, those eejits are coming to me and asking for my advice. In my opinion, we should keep it simple and plain and just help people. If a person is abnormally big, do not laugh. Let us all try to encourage them. We have an opportunity to help people.
I do not mean to be hypocritical but I cannot get over the difference in the five participants over just four or five weeks. It has generated admiration throughout the country. I thank the witnesses.
Dr. Eddie Murphy:
I cannot speak for industry because that is a commercial interest. I am talking about Irish society from the point of view of our health budgets in the future and the sustainability of our people. Each time a person is overweight he or she uses more of our health resources, and our health resources are decreasing. If we maintain people's weight, we will maintain a higher quality of life. One of the areas we have not covered today is the issue of mood and depression. There is evidence that mild to moderate depression can be treated through an exercise programme. It goes back to what Dr. Orsmond said in the context of medication. We should treat the cause, not the illness.
Have you received a response from any of the retail chains or the industry to say they will move two or three aisles in a pilot scheme, so the fruit counter would be in a certain place rather than the sweets or chocolate?
Dr. Eddie Murphy:
We are asking the Oireachtas to make the change, so people have better choices when they reach the point of sale. Twenty years ago people could have smoked in this room, but that has changed. Now people know it is not the norm to smoke. We want to create new norms in our society whereby health and well-being are the top priority. We want to shape society in ways that give people more and healthier choices.
Mr. Karl Henry:
To follow what Eddie said, in terms of the retail sector, "Operation Transformation" has received the biggest support yet from supermarkets. Tesco, Lidl, Aldi and Spar are on board this year and they have seen a huge increase in business via the foods that Eva recommends and healthy foods. They have made that commitment.
From the exercise perspective, "Operation Transformation" shows that people, and more importantly children, are receptive to change. They will make changes if they are given the tools. We have got that ball rolling. As was said, there is a void after the show finishes. We have started that process but the ball is now in the committee members' court, to legislate and get the simple messages across. We have proven that if the message is given, children, schools and parents will react. The members have seen the footage and the proof.
Dr. Eva Orsmond:
I was anticipating that somebody would ask me how we could save money in the health budget. We could save money through the measure of improving people's health. Type 2 diabetes care is costing the Government millions of euro. By reducing the incidence of diabetes by 10% we could save €145 million in the health budget. I see this regularly. It is not only early diagnosed diabetes but also diabetes that has lasted well over five years. People are on insulin medication which is costing the Government a fortune. We would have to incentivise people if the disease is due to lifestyle. The threshold for the medication could be increased. We should have some sort of incentive to stop taking the money from the vulnerable people whose lifestyle can be changed.
I am not in politics but my comments are based on my surgery and the patients I see. I have patients whose medication costs the Government €400 per month. Once patients lose the weight they basically only spend €20 or €50 per month on medication. This is all realistic. Obviously, not everybody has the will power or the resources at present. However, if one was given the funding to set a trial or show something like that, I am sure we could increase these numbers. We are talking about €145 million for a 10% reduction. One can look at the list of prescription drugs and what drugs are most often prescribed. Statin drugs are prescribed like sweets at present. They are based on trials showing there is a huge decrease in the cardiovascular risk factor profile, but many people are on these medications because they are told they have a genetic background for this disease. In reality, it is an environmental problem. Their parents were already overweight, they were eating in a certain way and they created the cardiovascular disease, not because it was genetical but due to their lifestyle. These people did not get it from their genes but from their environment.
We need to start looking at where we can save money. I understand that we cannot appear here and propose ideas that will cost more. We are in a bad recession and even though I am not a politician I know that. However, I have ideas on what we could do to incentivise and save money. It would also give people a huge improvement in their quality of life, more years of life and result in more productive workers. People would be able to create employment and get this country moving again.
Ms Monica Percy:
I wish to make a couple of points about the fun factor, particularly for children. Members saw the Step It Up campaign on the VTs. Children all over the country love that. Where I live the children do it every morning in school, and it is the same in national schools all over Ireland. Fun is the key to keeping children focused on keeping fit. If they are having fun, they go back to it again and again. It is the same with adults, and probably me. The same applies to food education and cooking. I have practical experience of this. During the programme my two children and I have been cooking at home and they love it. Perhaps we could facilitate something like that in national school. It need not be on a weekly basis but there could be cookery classes. Would it not be fantastic if every child leaving sixth class could cook a couple of dishes? When they eventually go off to college they will not be making beans on toast but healthy meals, and they will be able to shop properly. That is a massive contribution to society.
Mr. Gavin Walker:
I can endorse that. Members can see from the video that it was all fun and games when I tried to cook. It is hilarious to watch but the harsh reality is that I do not have a clue how to cook. I went from my mother's cooking to my wife's cooking. It was placed in front of me but when I was asked to do it, I could not. The committee can see the results of Eva's help over the last four weeks. I have been able to turn my cholesterol around. While it was not said on the video I was showing signs of fatty liver and that has normalised in four weeks.
On the point about medication, I went to the doctor and had blood tests before going on the show. He wanted to put me on tablets for my high cholesterol, but I have turned it around in four weeks through diet alone. These are all important and valid points.
I thank the witnesses for the presentation and I thank the participants for appearing before the committee. I recently spoke to somebody who made a presentation at a meeting of general practitioners, GPs, and practice nurses. The presentation was not about obesity but the person decided to touch on it because of the problems the person was having in their hospital clinics. The person was very surprised when the GPs said that they would not raise the issue of being overweight with their patients unless the patient raised it with them. The person was very concerned. This links in with what Dr. Orsmond said about prescription medication. Perhaps we need to start with educating GPs on dealing with this issue and using a diplomatic approach with patients.
In addition, the person was recently running a maternity clinic in their hospital.
They had four patients, with BMI measurements of 41, 43 and 45. To put the icing on the cake, if members will excuse the pun, the fourth patient was smoking 50 cigarettes a day. It goes to show that we are not progressing education. The witnesses have done more in a short period of time than what was done in the previous ten years, and I congratulate them on that. Deputy Ó Caoláin mentioned that we all have a part to play. The medical profession has a part to play and I am not sure it has been involved sufficiently. We must approach that matter.
I thank the witnesses for coming in and I applaud their courage in putting themselves forward for the "Operation Transformation" programme. How many calories should each of us take in per day? There is a message in what witnesses say in respect of listing calories. I suggest the committee write to the Dáil restaurant suggesting it lists the number of calories in the items on offer in the restaurant.
Should we have direct legislation on recording the number of calories? My sense is that we ought to have legislation because only a certain amount will be done voluntarily. People who are sporty will probably have sufficient exercise. There is a need to focus on how people who are not sporty can keep their weight down. That is a challenge for the witnesses and for committee members. Walking is an example. Part of the problem is that nowadays, we do not exercise in the natural course of events because we tend to travel by car. In the past, exercise happened naturally.
I wish to focus on schools and parents. Before election to the Dáil, I was a teacher so I am aware of the difficulty of encouraging children to eat healthily. If we are to succeed in getting children to eat healthily, it is very useful to have their parents behind them. Even if the children agree with the teacher in theory, when they go home they eat whatever is presented to them. It is a difficult challenge even where we are presented with obvious health reasons to do it.
I thank the experts. The leaders look great. I love the seven-point plan and I am trying to mull over it. Can the medical witnesses comment on birth weight? People say that it is genetic and that they cannot lose weight. With regard to the psychologists, I come from a teaching background and always found it very difficult to talk about weight in a classroom because of the possibility of pinpointing and embarrassing one or two overweight children. The teacher worries about bullying and psychological effects on the child. I am also interested in the points made about mood and depression. Are helpful figures available on that?
Reference was made to stepping up. What did children do to go from 2,000 steps to 15,000 and 30,000 steps? Can we get the message out to parents? As someone who has done every diet in the book, even though I thought I knew everything about food I had to get someone to help me to lose a stone and a half. One reads all the diet material and the calorie count but one forgets to balance foods and to eat protein and carbohydrate. We have very poor knowledge of food and cooking. I am not great at the latter. How do we get the message out to people? I have read that teenage girls drop off at 16 or 17 years of age and do not get involved in exercise from that point on.
How many of the family members of the witnesses have changed their lifestyles since they enlisted in the programme? Have they changed their lifestyles because of the participation of the witnesses in the programme? In going to schools, did the witnesses find children in poorer areas were more obese than those in more affluent areas?
My third question concerns parenting and the responsibility of parents. Do the witnesses think parents are being let off the hook if we expect schools to take on that role? There are 84 waking hours in the week of a child and, of that, only 25 hours are spent in school. The witnesses referred to the importance of education and fitness in school, yet the first reference was always to school rather than parents, who seem to be second or third on the list.
I grew up in a big family in a working-class area. I was in the attic the other night looking for a photograph for a book. I came across a box of photographs of children, including myself, who used to go on club holidays with Sunshine House. I did not see one fat kid in the photograph. I was 18 years old at the time and I was a size 6. The difficulty is that parents depend on everyone else outside to do things for their children. We have lost the value of what it is to be a family and to sit at home. Children do not bring the basket to the supermarket counter; adults do. We are responsible for what we put in it.
I happen to be a good cook, and I am not afraid to say it, because my mother was a good cook. We had basic meals. There was always bacon and cabbage and home baking. Brown bread or biscuits were always being made at home. We did not have money. We got a cake from Johnston, Mooney and O'Brien with a little cherry on top on our birthdays. People were not buying cakes for €50 for their children. The most important point is that we have a responsibility when we bring a child into the world. From day one, no matter what else we do, we have a responsibility to teach them to be sensible adults and grow up in good health. Now, we are depending on outside influences, including the "Operation Transformation" programme, which encourages parents to take more of a back seat. I do not agree with that and I think parents should be more proactive and get involved with their children.
I have one son who never played football because I was always on the sidelines screaming at him. I have four daughters, none of whom play sport, but they are all conscious of their weight and what they eat. That came not from outside but from being around the kitchen table. We always have our meals sitting at the kitchen table. None of my children, who are grown adults now, would have been allowed to have their meals sitting in front of the television. There is a lesson for all of us. One of the witnesses referred to plain, good old-fashioned eating. Most of us were reared like this and we need to go back to that and place more responsibility on parents when they bring children into the world.
I thank those who have presented to the committee. Recently I heard a statistic of which we should all be conscious. This is the first generation of children whose life expectancy is shorter than that of their parents. There is an onus on all of us to tackle that. Dr. Eva Orsmond made an important point on obesity. We are in straitened economic times but there is money to be saved.
The obesity problem is costing the health sector alone €5,700 every single minute of every single day. There is plenty of money to be shaved off and invested in other sectors of the health service.
Dr. Eddie Murphy touched on the issue of mental health that is continually ignored. The five leaders from "Operation Transformation" are a good example. The attitude change, with the leaders making dramatic changes in their outlook and perspective on life during the course of the programme has a significant benefit from the mental health perspective.
We are raising the challenges relating to suicide in society. I think we can assist society if we focus our investment on mental health. It is about an attitude change. As Deputy Catherine Byrne said we must try to give parents the tools so that they can assist their childrenand thereby change that statistic. We all wish that children will have a longer life expectancy than their parents.
It was only after it was mentioned here this morning that I recalled that in some supermarkets one must go out of one's way to find the fruit and vegetable section. Other supermarkets are designed in such a way that one is forced to go through the fruit and vegetable section. I think that even that small step would be a step in the right direction that retailers could take immediately in many cases.
Dr. Eddie Murphy:
A number of interesting questions have been raised.
Let me invite committee members to think about the concept of the "Nudge Unit", a behavioural unit that is being adopted in the United Kingdom and America, which has been used in a number of situations, for example in dealing with teenage pregnancies, health choices and paying tax. They have saved significant sums of money in terms of nudging people to make better choices and it answers the questions on the role of parents. People thought that fewer would cycle in Ireland when the cycle scheme was introduced in Dublin, but it turned out that it became the social norm and bicycle sales increased.
We need to create new social norms in order that we need to distinguish between entertainment and eating. Sometimes we eat in front of the television. We need to provide structure so that people are eating with the family around the table. There is an increased incidence of obesity in poor children and in working class areas. Senator Colm Burke raised the discussion on weight with health care professionals. It is almost that obesity has become the new stigma. It is a bit like talking around suicide and mental health. We need to drop the diplomacy and have honest and real conversations and give people the capacity and the language to have conversations that engage people to say "This is where I think you are at". Rather than lecturing people, we must invite people to change and they may come on board. If one lectures people, they will step back and go back into child mode and rebel against the advice. One needs to change the process and invite people to take help to engage in the process of change. "Operation Transformation" remains on the website throughout the year. It is a free programme and people can commence the food and exercise programme and engage in change. The programme raises awareness and gives them a focused awareness so that they understand the process. At present being overweight and obesity are seen as the norm. Young people of 14 years weight 3 stone 7 lbs more than their grandfathers did at the same age. I think that is incredible.
Dr. Eva Orsmond:
I conducted research on the need for weight management among hospital staff members in Loughlinstown hospital in 2000-2001 with Dr. Donal O'Shea. I assessed 260 out of 350 members of staff, including doctors, nurses and hospital staff members. I showed that the hospital staff members were not doing any better than the rest of the population, which is totally understandable. From a public health perspective, these people are going to be the starting point for change because they are the ones who make the first intervention. They are the ones who get advice from a public health perspective.
I am from Finland and worked and lived there for many years. The Scandinavian countries have good public health outcomes and money is spent on prevention. I am not here to look at the weight of doctors, but they are living in this society and their overweight levels are similar to the rest of the population. It is very unlikely overweight and obese doctors will raise in their professional capacity an issue of weight or lifestyle if they themselves do not feel they are a good example. It is very difficult. We need to provide the knowledge and education on nutrition to help hospital staff members and medical professionals. This is the point I was focusing on - knowledge and education. At present, doctors have very little if any nutritional education as part of their curriculum. Children do not learn anything about nutrition or food unless they take home economics. Even if we are raising awareness of the numbers, we all know we have an obesity epidemic so we do not need to do more research on that. We know it already but what step follows highlighting the problems? Who gives the advice and what advice is given? Even if we put the calories on the menus, people still need to understand that calories on their own do not mean anything, one needs to look at the protein, vitamin and mineral content of the menu. My concern is that concentrating on counting calories without considering the nutritional content could lead to other problems. In the end I believe in the fact that everything starts from the family. I am the mother of two children, but we need to have the professional giving support to families. That is what I mean by support from doctors, nurses and teachers. Anybody who has children knows how difficult it is to bring up children. Once they go out their front door they are standing against the world. It is not always an easy place.
Dr. Eddie Murphy:
It is the absence of parental knowledge. It is about empowering parents to support their children. By creating awareness around what is normal weight, children who are in trouble with their weight are weighed during their contact with the health and education services. When they are weighted we have the data to say there is a difficulty.
I want to correct something as I think there has been a misunderstanding about what I said. People and parents need to be educated, but there are groups working in every community to provide youth clubs, the GAA, football clubs, scouts and guides. I would like the parent in Tallaght to be asked whether she was involved in anything with any of her children. I think it is very important that parents be involved in activities with their children.
There is a trend from active play towards sedentary play among children. I have noticed that during my career in teaching. There is an inclination to drift in that direction and that has a bearing on the debate.
Mr. Karl Henry:
From the perspective of "Operation Transformation" it is great to see such a passionate response to our presentation. That is exactly what we hoped would happen, that our seven key points would be taken on board and would create a debate, which is great.
From my perspective, the family unit is key in terms of solving the problem.
I know on a personal level from the work we have done with parents' associations and in schools that it all comes back to the same factor. The knowledge is not there in terms of what is healthy and not healthy on a school or family level. Across the board there is a massive lack of education and knowledge.
Mr. Karl Henry:
People are confused. There is no simple knowledge out there. What our seven-point plan promotes - this will have been seen through the VTs - is a simple, effective, measurable message through an organisation, whether it is the schools or the Gaelic clubs or whatever is the organisation. The infrastructure is there. If the message is built and provided, it will filter into the community through the teachers, parents and schools. There needs to be a multifactorial approach in terms of solving the obesity epidemic we are facing.
Mr. Gregg Starr:
I thank everybody for their good wishes and support. The support from the whole nation has been fantastic. Somebody asked how our have families changed. The whole community around us has changed. We now have up to 100 people out walking every night. A friend of mine who owns the local Chinese takeaway gives out to me weekly for his loss of business. I keep apologising to him and say that is just the way it is and to get used to it. Our families and the whole town has changed. Everything has changed. People's attitude has changed. A group of people who walk during the day, walk every night also as a social activity. People are getting out of the pubs and are beginning to talk to each other. We live in a very small community, Borrisokane, which has a population of just over 1,000 people. There are people there who did not know each other. That would not have happened years ago. When we were younger, everybody knew everybody. Children got out, climbed walls, ran through the fields, swung off trees and did whatever children were supposed to do but children do not do that any more. There is a huge responsibility on parents.
My son, Eoin, is in the primary education system. The success of the "Be safe, be seen" campaign, is due to the wearing of high visibility jackets which are everywhere. There is also the seat belt sheriff campaign and the green flag campaign for the environment. Their success lies in educating the children and educating the parents, as primary schoolchildren bring everything home, good and bad, to the parents.
I had no idea of proper diet or proper control before the show started. The only exercises I knew were those I did myself. I stopped exercising and stopped watching what I was eating and stopped weighing myself because as a man I never did those things. I never looked at what my wife did. It was not until I stepped up on the weighing scales one day and saw that it registered 20 stone that I thought something had to change. We have to monitor ourselves, weigh ourselves and our children and educate children and parents on what we are eating. There is so much rubbish in processed foods. When one eats fresh, one stays fresh and one's life is fresh. I believe a good national campaign, which does not have to cost a lot of money, would help educate primary schoolchildren in moving and eating correctly. The children will bring home the message and the parents will move with them and will realise that what they are feeding their children is wrong. The five of us have always said we hope we can encourage people to get up off the couch, be they seven years of age or 70 years of age. That is what we are here for and that is the most important issue for us.
Ms Deirdre Halford:
My husband has been doing the programme with me and is eating the same foods as me and he is one pound ahead of me. I was doing so well. I notice my mother, who would not be keeping to the programme, is eating healthier. She is having brown wraps instead of white bread. Dr. Eva gave me some advice recently about my son. I was cooking a dinner for us and a dinner for him but now he eats what we eat and he loves it. My whole family's eating habits and attitude to exercise have changed. Five weeks ago I would not run across the room and now I am jogging, thanks to Karl's plan. They see me taking exercise and say that if I can do it, they can do it. Now they are doing it too. It has changed the dynamics of my whole family.
Ms Charlotte O'Connell:
I speak for my family as well. I would always have been the heaviest in my family. My mother and father were healthy eaters. In terms of lifestyle, they were always healthy, as were my sisters. Since I have taken on the programme, my family is more conscious of what they are eating in terms of calories. At my workplace there are 15 girls who weigh in every Monday night. The canteen has taken to cooking all the "Operation Transformation" lunches and it makes people more aware. I have to say it has been fantastic.
Ms Monica Percy:
It has been the same in my family. My two children have changed their diets completely. They have lunch boxes going to school. They are cooking one night per week unaided, which is brilliant. It goes way beyond our immediate families and the villages in which we live. It is clear from the feedback that everyone appears to be on board with Dr. Eva's recipes and Karl's exercises. I just hope we can continue beyond the end of February.
Dr. Eva Orsmond:
That is most important. We know that Ireland has the lowest level of breast-feeding, which is obviously where everything should start. I could not be a better promoter for breast-feeding, having done it twice and coming from Finland a country which has one of the highest levels of breast-feeding in the world. Obviously it all starts there and it is vitally important. It is all about education. Primary health care prevention is there in its place.
Dr. Eddie Murphy:
It is how we do it and finding the language to do it in the classroom. There is a concern because in the new structures in the child and family services there is an amount of psychology. In Ireland we train 35 clinical psychologists per year, which is a very low number. In terms of the new configuration in the health service, there is a concern that the activity for children in primary centres will change because there is a risk that psychology will be plucked from primary care and put into the new child agency with a child protection focus so they will not have the professionals on the ground to support teachers and give them messages. There are some very good programmes that can take place in the school environment, such as the friends programme which looks at building school resilience in the primary school setting and can support the conversation about increasing the children's resilience and self-esteem. One of the areas of concern about bullying is to try to impact on the bystander, to increase the role of the bystander to intervene. If that happens, it would reduce the amount of bullying and the consequences on the self-esteem.
Are Members aware the restaurant here, as a consequence of politicians taking part in "Operation Transformation" a few years ago, has an "Operation Transformation" option on the menu? If Members agree, we will write to the House services committee asking it to consider the possibility, in the medium to long term, of including a calorie content on the menu. Is that agreed? Agreed.
I welcome the witnesses from "Operation Transformation" and the team leaders. Although not a member of the committee I wanted to listen to the conversation that has taken place. The presentation was the most inspiring I have witnessed in any of the committees on which I have sat in recent years. In regard to the restaurant, I do not think the issue is the calorie count but to go light on the portions put on one's plate. It takes discipline to say that.
As one who has run 100 to 120 miles per week to achieve whatever goals I had in my sport and being very conscientious about proper diet in order to achieve excellence, I was fortunate to be reared in a family that educated me in exercise, running around the streets of Drimnagh. I am fortunate that my children and nobody in my family has health issues, such as obesity. I am fortunate that my little grandchildren of one and four years of age are already developing literacy skills. This is where we have to nip it in the bud going forward. We can talk in here until the cows come home. We can talk about the seven-point plan and the wonderful suggestions.
Those seven-point plans are a no-brainer. We all know about them. It is all the simple things. Implementing change is the most difficult aspect. The Department of Education and Skills, the Department of Health, the Department of Agriculture, Food and the Marine, the Department of Children and Youth Affairs and the Department of Transport, Tourism and Sport all do wonderful things in many different areas around the country. We need synergy, with everyone coming together. There is an old cliché about obesity. Sometimes I look at people and wonder how they could have allowed themselves become so overweight. We are what we eat. What one puts in and what one puts out makes the difference. I ask the team leaders, if they were to turn back the clock to being very young again, what changes they would make.
I apologise, Senator Coghlan, as there is a vote in the Dáil. We will suspend the sitting. I apologise to the leaders and the experts. Votes are part of democracy and we have no control over when they are called.
I have lost my train of thought - I was on a runner at the time. The point I was making is that it is all fine coming with all the information in the suggestions and in the seven-point plan that was discussed, which is something about which we all know, but the issue is how we implement change. There must be paradigm shift in thinking among a number of Departments in order for action to be taken.
When I introduced my Points for Life initiative in the Seanad 12 months ago-----
Yes. I will come back later to the Points for Life initiative and where it is at now. When I visited schools I met the principals the physical education teachers and one of the questions I asked was where physical education sits in terms of priority on the syllabus in primary school. It is at the bottom. Where does the physical well-being of the children who are going to school sit in terms of priority? It is at the top. Why is physical education not taken seriously in schools? It is not really taken seriously in schools.
Karl mentioned the points for fitness. My Points for Life initiative was the subject of a motion in the Seanad, November 12 months ago, and on foot of it a committee was set up and it met representatives of schools. Professor Niall Moyna, Professor O'Shea and one representative from five Departments were on that committee. We met month after month and discussed the exact same issues at our meetings as we are discussing here today but the question is how we bring about change. I was getting completely frustrated with it at one stage and I said "Forget about it". Coming from my background in sports I understand how simple it is to implement these changes. We did that with the children in my running community from a young age and they have now become adults and parents themselves and they understand the benefits they got through education.
If we consider the education side, Senator Catherine Byrne referred to parents. This must be parent-led, schools-led, national governing bodies-led and community-led and they also must come together. However, everybody wants to go to the schools, whether it is to deal with the issue of cyberbullying, physical fitness or obesity. The notion is put forward that in order to deal with every issue we must approach the schools. However, the biggest problem I have in implementing the Points for Life infinitive, and it is points for life as opposed to points for college, are the school teachers, the various unions and the training colleges. The reason for that is that from my research and the meetings I have had, I have discovered that in terms of physical education delivery in primary schools, there is no real qualifications for delivering simple programmes because physical education is basically to play a little bit of ball here and play a little bit of ball there. We have to nip it in the bud and instill fundamental skills, not only physical literacy skills but movement skills in young children because I have seen the benefit of doing that. If we can instil those fundamental skills in children they will become secondary school students and later parents and ten, 15 or 20 years down the road they will instil those skills in their children.
I thank the witnesses for their presentations. It is great to meet all of them. I have watched the programme when I get to do so and it is fantastic. There are so many issues I would like to discuss that I do not know where to start. On the parenting issue, I agree with the previous speakers. The parenting issue is important. We do not only need more education for children in this area in primary schools but parent education is also needed. There are parenting courses in existence but it is very hard to approach that subject without being somewhat patronising. We need to embrace the whole area of food education and parenting education generally for parents at large, pardon the pun. In general, childhood obesity cannot be blamed on society or on the child. It must be the parent who is primarily responsible for that. We need to extend the witnesses' points on education in primary schools to parenting education.
I would also be interested in this issue in terms of when students leave secondary school. That is when I felt I fell out of touch with physical education. It is then one becomes somewhat focused on other things but I know that depends on the individual.
The Count Me In idea is a great one. Is that one the witnesses' would envisage for fast-food type commercial enterprises? It would create practical difficulties for restaurants and their owners to adopt given that they may change their menus every day. I heard a good deal about that from the restaurants associations, etc.
On the issue of low fat products, and this is probably a question for Dr. Eva, one hears of the fat and low fat content of products but when I see a product with a low fat label, I think chemical explosion and I do not want to eat that food. I am at a level where I am nearly over-educated about food and I need to relax a bit. I am probably a bit obsessive which is another issue.
On the issue of GPs, in which I am interested, educating GPs is fine, but we need a stricter code whereby if somebody presents with these certain levels at a certain stage, the GP should be compelled to put the person into a programme, although that might be a bit harsh, but there should be some onus on GPs to address the issue. On the nutrition point Dr. Eva raised about GPs, I have four, five or six friends who are GPs and they do not have a clue about nutrition. They are the very ones who will go on crash diets and advocate ideas that are bonkers. Nutrition is something GPs do not know about and many speakers have addressed that point.
The difficulty in speaking at this stage is that previous speakers have made the points that I intended to make. There is also the psychological issue and I do not necessarily mean mental health but mental health can be very much enhanced by exercise. I mean the psychological issues as to why somebody is overweight. I have very personal experience of this and that is something that needs to be addressed. It is easy for Dr. Eva, with the greatest of respect, to say that we should take a person off medication but there are reasons, deep-rooted psychological reasons sometimes, as to why people are overweight. That is an issue we would also need to address.
Healthy food choices are difficult to get.
I am not a member of this committee but I am passionate about this issue and that is the reason I attended. It is important to make it easy to get healthy food and the Chairman spoke about that in terms of here in the Dáil. One has to make a serious effort in many environments in Ireland to get healthy food.
If one is at a match, one cannot possibly get fruit along the way. We must find ways outside school and in other places to make it easier for people to eat healthily. My Seanad colleagues, especially male ones, would love to find it easier to facilitate a healthier lifestyle. I could go on forever.
I thank everyone for attending, especially the leaders. As someone who has struggled with her weight all her life I had to think twice about coming to today's meeting. I find it very difficult to talk about it. That is unusual because I am a politician and the only woman who stood in two elections in a male-dominated area. I usually cast it aside. As women politicians we are often scrutinised about our appearance. The online chatter when we make a television appearance is often about what our hair or double chin looks like rather than about what we say about the politics of the day. A lot of Irish women struggle with their appearance.
I agree with much of what has been said. I am a mother of a young daughter. We all struggle to try to manage our time. Sometimes we have very little control over what our children eat. It is not just about shopping. As a working single mother I rely on child care and childminders to be able to pay my mortgage, and I spend time with my daughter at the weekend. That is how I manage my life. It is not perfect but that is an issue faced by many. We must have a modicum of reality.
What the leaders are doing is amazing. It is fantastic. They give people like me great confidence. Perhaps I should be more proactive. I hope that I will be after this meeting. We must be realistic about how time-poor people are. I do not say that as an excuse. I can see Dr. Eva’s eyebrows rising already. It is not an excuse. I am sick of people blaming the education system for mental health, sex education and health problems. Children are raised in communities and it is people’s attitude to exercise that counts.
People talk about exercise and getting involved. My daughter is actively involved in the local hockey club and the local GAA club. We get notes home about the crazy driving behaviour of parents bringing their children to sporting activities. People are driving who live five or ten minutes away, including me. We must think about that.
Another issue was raised about young teenage girls. I was active as a teenager. I was involved in basketball and athletics but the focus was always on winning, not on taking part. That is a problem because not everyone is going to be an Eamonn Coghlan. We need fitness. The emphasis in this country is always on competitiveness and that is a problem.
Another issue of concern to me as the mother of a young daughter is that as a punishment if one misbehaves in school one is told to sit out from PE. What kind of message is that sending to children? That happens on a regular basis. Children misbehave. Anyone who has children knows that. My child is a bit of a chatterbox. I am sure she is a bit of a nuisance at the back of the classroom from time to time. Her punishment is to sit out from the 40 minutes of exercise provided in a week. We must examine the message we are sending to children in terms of the competitive behaviour displayed by parents on the sidelines and also as a result of the fact that the focus of clubs is always on winning and not on taking part. In defence of some clubs, the GAA has been excellent in trying to get women in particular involved by encouraging mothers to train alongside their children when they bring them to training sessions.
A worrying revelation is that the number one reason young teenage girls give for not wanting to do exercise is that it would make them sweat. That is the reality. What kind of society are young women growing up in that they are afraid to sweat in front of their peers? We must be realistic about the challenges that exist.
Could the leaders give me one tip that I should follow tomorrow morning in order to try to change?
I thank the witnesses for attending. I add my appreciation to the efforts the leaders have made. There is about 20% less of me than there used to be ten years ago so I have some sense of the scope of the struggle that is involved and the ongoing commitment required. Imagine what I would be like if there was 20% more of me. I would be even worse.
In my day job I am increasingly focused on dietary issues because quite a few patients in my practice who have had breast cancer treatment have survived and are coming back for follow-up visits. The one thing that has emerged in the oncology literature in recent years is that in addition to the other well-recognised health implications of obesity and overweight there is also an increased risk of cancer. Not only that; there is an increased risk of the return of cancer if one has had it. That makes it a real and practical issue. I spend time taking dietary histories. It has forced me to the conclusion that we all need to know: it is not all about good food versus bad food. It is sometimes too much of the good foods. In fact, frequently it is too much of the good foods. If one talks to an average middle-aged or elderly person who is obese, they are not eating crisps or cakes but they are having a great big feed of spuds every night with their dinner. They sometimes cannot understand why they are not losing weight. As well as the quality of food we must focus as well on the quantity.
There is a whole parcel of things related to education in the medical curriculum. One of the most powerful interventions for the treatment of smoking or weight gain is for a doctor to sit down with a patient and talk to him or her. That is powerful and carries a weight that many other interventions do not have. One must incentivise doctors for all the reasons Dr. Orsmond has told us about.
The most extraordinary example of muddled health economics is going on currently. It can take six years to get bariatric weight reduction surgery in this country. The aggregate waiting list to see someone in the obesity clinic and then the waiting list following the clinic for those recommended for surgery can be six to seven years. It is desperate. During that time, the cost of treating those people, many of whom will die, for diabetes and sleep apnoea, which is unbelievably expensive to treat, is high. It could be cost-neutral if we could shorten the waiting list and offer more people nutritional counselling.
Dr. Orsmond referred to the unhealthy lives of Irish doctors compared to those in Finland. There are approximately four times as many hospital specialists in Finland as in this country. She referred to a specialty. In oncology the figure is 6:1. We have a bizarrely understaffed medical structure in this country, which is not good for the health of doctors or their patients. It means there is no opportunity to sit down and have a ten-minute or 15-minute conversation with someone about his or her weight when the waiting list is full of another 120 who are waiting to come in to see one, who in turn might save the health service money if such a preventative intervention is made. There is a real need to examine the situation.
To give some perspective to the witnesses in terms of the committee's sincerity about public health measures, this is the same committee which two months ago voted not to make Leinster House a smoke-free campus.
Every single one of the witnesses looks amazing. It is probably one of the better presentations I have heard, and one of the most interesting. We can see the results in front of us. Reference was made to a seven-point plan, which clearly works. We have evidence of it sitting in front of us as well.
When I was younger children played outside all day. The television was not put on until 6 o'clock in the evening, and there were no video games. There was not a lot of money and many mothers worked in the home. In general, when one came home from school the dinner was meat, two vegetables and potatoes. There were no fizzy drinks. Biscuits were a treat perhaps once a week. Cake was for birthdays or an occasional treat. There were very few fast-food outlets. People did not have a lot of money. Fast food and ready meals were not available. Our lifestyles have changed and everything has shifted. People went out to work and time became important. People were doing shift work and unsocial hours.
Fast food such as pizza was always the best option for parents rushing to work, but we must reverse that, and the only way we can do it is by working collectively through education. We must start in schools by educating the children, and the children will then educate their parents. Those children who are now educated will become parents and therefore we can reverse the cycle.
I agree with everything in the representatives' five point plan. The Count Me In initiative is essential. If there were calorie counts on a menu I was reading I would think twice about what to order, and I believe many people would do the same. Having fruit at supermarket checkouts is essential. The Step it Up programme is essential, but we must make it fun for people to participate because not every child is interested in sports.
I take on board what Deputy Mary Mitchell O'Connor said about weighing in at school. We must take account of children's feelings because if it is not done sensitively, they could be bullied. We must view it that way.
We have to address the problem of childhood and adult obesity. We have an opportunity to address it collectively and perhaps bring forward legislation that will give people a chance. Most of the points were covered but I want to say "Well done". The representatives should keep the issue in the public domain because educating the public is vital. It is the only way we can combat this issue.
Dr. Eva Orsmond:
It is brilliant that we all appear to agree on these points, and that the leaders have done a fantastic job. We must come back to the point that the leaders' success is the result of our seven-point plan. If we have a seven-point plan, what are we waiting for? We should just implement it.
Dr. Eddie Murphy:
One member asked about the impact of "Operation Transformation". It is like a pebble. It acts on individuals and families. We have seen it acting on communities and on our society. We have 65,000 people interacting on Facebook, and we have had 3 million hits on the "Operation Transformation" website. We know it has an impact on different people.
Dr. Eddie Murphy:
I am in contact with previous leaders. About 80% hold their gains.
On the question of the psychological component, in the world of food it is not what people are eating; it is what is eating them. We should try to target that for some people. Today our focus is on preventative measures. For those people who are time-poor, it is about structuring society and the way we engage with our environment to nudge people towards healthier choices.
Mr. Karl Henry:
From my perspective, I will tie in with what both Dr. Murphy and Dr. Orsmond said. We are here to represent "Operation Transformation" as a brand, an entity, and something that in the past six years has got the nation moving in an increasingly bigger way every year. We have seen that in terms of the responses to the information we put on the website, which is available all year round. We have seen it also in terms of the viewing figures for the show, which are now close to 600,000.
"Operation Transformation" has been so successful because we keep it simple. That is one of the key components we came here today to discuss with members. It is fantastic to get to talk at a forum but often the message gets lost in translation, picking on one element of society or another. The reality is that our seven-point plan is a multi-factorial process to get people fit and healthy.
On "Operation Transformation" we looked at children, and Step it Up is the campaign we used. We kept it simple and got the results. It was nothing to do with sports. It was giving children a goal and a method to achieve that goal, measured by the teachers or the parents, and they succeeded in reaching it.
With regard to adult obesity, we built a website and showed people how to cook food and exercise. We asked them to walk three times a week. We gave them a goal of a 5 km run in eight weeks and a training plan with which to achieve those goals.
The show has 600,000 viewers. It is the single biggest health programme Ireland has ever had, and it is getting more popular every year for one reason - we are more unhealthy and heavier than ever before. People want help. They want the message and the knowledge. We do not get lost in translation. We promote simple messages that work. That is the reason the show is successful. We believe our seven-point plan will be successful for the same reason; it is simple, effective, and easy to implement and measure. We are giving people the tools to succeed on a multi-factorial level. It does involve the schools and the parents.
Everybody in society has to change through whatever structure. We believe that children are the key to this change. They will be the Senators and TDs ten, 20, 30 or 40 years from now. They will be sitting in committees such as this one. Will they be heavier than the people we see here today or not? That depends on the legislation we put in place in the coming years.
We are here to present our seven-point plan on behalf of the show. It will work. We have shown members footage. They may have sat through presentations in the past and listened to fantastic statistics. We did not do that. We kept it simple and visual. We showed members the results of our progress. We have five fantastic leaders who have literally transformed the nation through their progress by using simple techniques and tools. They cooked healthier and better food. They set goals with Dr. Murphy and, from my perspective, they moved a little more.
This is not a quick-fix solution; it is a long-term solution. We have proved that it works, and we used visuals today to show members that. The proof is on the screens. The key aspect is not to get caught up in too much talk because the message gets lost in translation. By keeping it simple we have proved this works, and we have shown that to members. We hope that because we are keeping it simple, one or more of our seven-point plans might be in place by this time next year when we can come back here and pat all the members on the back for the fantastic job they did in implementing one or more of those measures. If we get one of those over the line we believe we will have healthier, happier children but also a healthier, happier nation. If members want proof of that I ask them to come to our 5 km run next Saturday week, where they will see 5,000 people who were sitting on the couch eight weeks ago. We gave them a goal and the tools to achieve that goal. Members should come along on the day to see the feeling of pride and emotion when those people cross the line, and how happy they have become over the course of an eight-week timeframe. The results are there for all to see, and we hope members take something from that.
Dr. Eva Orsmond:
I would like to respond to the comment about the very long queue for bariatric surgery. I would not even mention that because I would be ashamed of that. If a country has a very long queue for bariatric surgery it is a sign of a very sick society. We should not even get that far because that means we are again treating the symptoms and not the cause. That is not a solution. We should start dealing with the problem long before that, and it comes down to education. All the members have agreed that the starting point must be at home with parents, but if the parents do not know how to educate because they do not have the knowledge they must be given the tools to educate. That is where it must start.
We must not drift. We must remember that food is what we put in our mouths every minute. We were taking pictures in front of the House at 9.30 this morning and four teenagers walked past us eating crisps. I am sure all the members noticed that. They were eating crisps at 9.30 in the morning passing by the House. If those children were smoking the members would have said, "Goodness. Children smoking at that age," yet they are allowed to eat crisps at 9.30 in the morning.
I agree with Dr. Orsmond, and there is a strong parallel here with smoking. We would like people not to smoke and as a result of their not smoking we would have fewer cases of lung cancer. However, that would not mean we did not need to provide treatment for people with lung cancer.
The reality is that some really established leaders in the fields of diabetology and metabolic medicine say that, for some patients, bariatric surgery is needed. The reason we have a long waiting list for it is not that the demand is so great, although it is growing, but that we have systematically under provided for it in the way we have systematically under provided for most tertiary care. That is the reality.
Dr. Eva Orsmond:
One must also consider the type of dietary advice patients have been given before reaching the point of bariatric surgery. Even the diet they are put on after surgery is such that they are starving. There are nutritionally debalanced because the appropriate system is not in place. All our nutritional guidelines are outdated by at least 50 years. We are still following the food pyramid, which is only good for somebody who is farming with horses. The only way of eating according to the food pyramid is if one is physically active, or if one is a personal trainer from morning to evening. We need to examine what we are teaching people. Doctors are sending patients to dieticians who are following the guidelines. Doctors are not monitoring what advice they are giving. I know a number of endocrinologists who would back me up in stating the guidelines we provide to patients at present are wrong.
Dr. Eva Orsmond:
It does not help to blame. We need to start building on the knowledge and actually put what is required together. There is no easy solution. That is why we are trying to say that we should start from simple steps. That is why we have tried to create a seven-step plan. Even if one just used one aspect, one would get far.
Mr. Gavin Walker:
For me, the easiest thing to do is log on to the website. One can start at day one when one logs onto the website in the morning. The exercise plan involves half an hour per day. Everyone can find half an hour within the day. The food plan is in place, as are the recipes. While one can start at day one, we are on day 35 or 39. One can start at the beginning and keep on going.
Ms Monica Percy:
I am a bit like Deputy Ciara Conway in that I am a single working mother and know exactly what it is like to be busy. I got into bad habits. Takeaways are very handy when one is moving from one activity to the next. I got assistance in the programme to examine how I was handling matters. My two children are of an age at which they could get involved more. It is a question of sharing the load at home a little more. When I have time at the weekend, I do some bulk cooking so that when we are in a rush to get somewhere, there is something to hand. For this reason, I do not suggest going to the chipper quickly. A little planning is required. Effort is required initially but it is very much worth it.
Mr. Gregg Starr:
Let me answer Senator Coghlan's question on the one thing I would change if I were to go back in time. When I was in my mid-teens and especially between 18 and 20, I was not conscious of what I was eating. Many young men do a lot of sport and are active but do not use the weighing scales. The one change I would make would be to become conscious of what I am eating.
I hope I can pass on the message that if one is not ready to do exercise and diet, one should not do so. One's head must be in the right place. When I hit the 20-stone mark, I said I had enough and would change. I had believed I had tried eating correctly and exercising, but I was not putting my heart and soul into it. When one's heart, soul and brain are ready to change, one will change. That is the most important point for me.
Ms Charlotte O'Connell:
All the points are completely valid and I agree with every one of them. For me, it was a matter of realising I would not get rid of the weight in a couple of weeks. In diets I have done, I have under-eaten and over-exercised. While I lost weight, I fell back into old habits really quickly. It was a case of realising that I had to follow a plan and have goals.
Ms Monica Percy:
It is a question of balance; one has to have a little treat also. I have been doing so over the course of the few weeks. I have been having an occasional drink or other treat. I need a treat because if one gives up everything one initially loved, it is hard to stick to the plan in the longer term. However, if one feels one wants a little treat, one should have it and continue with the good stuff for the rest of the time. That works.
Ms Monica Percy:
I am similar to Ms Halford in that I never really liked exercise when I was young. I did a lot of dancing but never really took part in sports, as such. When I got older, I was almost a little embarrassed to get involved. I did not want people looking at me sweating while running, for example. As part of the programme, I have finally started to enjoy the running. I never would have imagined this. I wish I had taken a chance earlier. One must find an activity that is fun. If it is fun, one will do it again. If it is not, one will not go near it.
Ms Charlotte O'Connell:
I totally agree. I did not really take part in sports. Many of my friends were into the GAA. I regret not having played football, for example. As the years went by and as I got heavier, the more embarrassed I was by my weight. At that stage, I definitely did not want to take part.
I have lost a lot of weight over the years. One factor, a really abstract one, that I believe is really important is hope. It is important to keep hope in one's soul. I have brilliant parents who instilled in me a sense of hope. I actually never experienced many of the difficulties that arise. Once one gets into the right headspace, it is like a train coming if one keeps focused.
A less cerebral factor concerns alcohol. We have not really discussed Ireland's relationship with alcohol, which is a considerable bugbear of mine. Alcohol is a significant trigger. Do the delegates have any innovative ideas in this regard? Senator Crown has an innovative idea about cigarettes of which I would be in favour, namely, to ban them from the country over a certain period. I realise this would cause all sorts of other problems and that it is a bit right-wing.
The delegates are promoting healthy eating. We have a problem with anorexia, particularly among teenage girls, and other eating disorders. Will the delegates comment on this? I am thinking about the psychology in the classroom. I am worried about the teacher delivering the course. Reference was made to psychologists but I have a difficulty in understanding the means by which we can send out the right message.
We always talk about schools. It is all about nipping the problem in the bud. The Points for Life initiative is about A, B and C, namely, agility, balance, co-ordination and cardiovascular skills. Food Dudes and other such programmes also come into play.
Schools are getting hit with everything but they do not want bleep tests because they do not want to show one child up against another. Schools do not want the step. When I say schools, I refer to the Department of Education and Skills. What the schools and Department are looking for is sustainability. With all due respect to "Operation Transformation", it is on for only six weeks. It has 600,000 viewers because it is a reality show.
These participants are stripping themselves down, physically and mentally, and fair play to them. They are motivated for six weeks.
The programme has been in operation for probably six years. What has changed in this nation in six years? Has the situation improved? No way. What we need to do is educate, through the medium of the schools, the NGOs, the NGBs and the communities. If we teach the fundamental movement skills and the agility skills to children - this is not about sports - we will find that their self-esteem and self-confidence will improve and the likelihood will increase of those children who did not get involved in sports at a younger age doing so now because they will have the confidence to be able to stand on one leg and close their eyes.
It is important that one gets support, encouragement and team spirit, and the most important part is one must have the determination to keep going. I have been looking at "Operation Transformation" for the past number of weeks. One week, one of them was supposed to lose a pound and did not, and the point about it is that one cannot let oneself get down. The more encouragement one gets from the mentors, the better.
In fairness to the mentors, I must give them ten out of ten. Sometimes they can be very cruel. According to the old adage, "You have to be cruel to be kind", but the good part is that they are still showing determination. I can see in their faces that they are disappointed when they do not produce. Sometimes, as people realise and as Mr. Karl Henry will confirm, fat weighs lighter than muscle.
Dr. Eva Orsmond:
The World Health Organization has claimed that we have an overweightedness and obesity epidemic. Anorexia and eating disorders are not an epidemic. We would need to concentrate on the more important issues. At present, these are overweightedness and obesity, not anorexia and eating disorders. These others are important but at present they are not the priority.
Dr. Eva Orsmond:
But I refer to the percentage. According to all the epidemiological data, this comes down in most instances to the society in which we live. For all the reasons that have been highlighted, and we know all that, the reality is that we sort of know where it is coming from but we do not know a solution to it.
Dr. Eddie Murphy:
Comments are one matter, but I will ask a question. I ask our leaders questions and questions bring about change. What change will the committee bring today? When will the members put calorie posting on a legislative basis? If consumers learn through the multiples, they will be able to understand what happens in their local small space. The question I have for the committee is when will the committee bring in calorie posting because that is the immediate step they, as legislators, can take.
Mr. Karl Henry:
To wrap it up from my perspective, to answer Senator Eamonn Coghlan's question on where the show has come in six years, we have come from being half an hour on television with a couple of hundred thousand viewers to being here with those who make law on behalf of the people. We have shown through our figures that people want to get healthy. Today, we have shown the committee the way in which to do it by keeping it simple. It is easy to get lost in translation and it is easy to talk around a subject.
In terms of the sensitivity aspect of Bleep tests and weighing in schools, that is all very well if there is one child in that class who is overweight or obese. The reality is that is not the case anymore. That is gone 30 years. It is much more serious than that. We need to get over that. If the Bleep test is brought in and one has a measurement, so be it. That is one's number. The goal for that year for that PE class is to get the numbers up. At every parent-teacher meeting, one is given a talk by the teacher about how one's child is getting on in a certain subject. Why not in PE? Why not be given a number, that one's child is scoring ten, seven, six or five in a Bleep test, as we have seen in Athlone when we have done that?
We are very proud. From my perspective, in year one, when I was brought on board to be the fitness expert, I never thought that six years later I would be sitting here talking to those who put the laws in place.
We believe our seven-point plan is effective. We believe we have shown the committee that on a visual perspective across the board. We are not using statistics that get boring. We have showed the committee it works on a child's level. Our leaders are here as representatives of the adult population.
With simple steps - food, goals and exercise - changes can be made. In terms of the leaders, this is week six. The children the committee saw in the step-it-up campaign earlier are four to six weeks into it. Look at the variations and what we have changed.
I want to make this observation because we all had a good opportunity to exchange our ideas with the witnesses. It would be remiss to give any notion that "Operation Transformation" has not hugely filled the vacuum in terms of addressing the need for awareness, which is crucial. It would be a sore note for our membership to conclude this meeting by failing to record that those involved with the programme have done a powerful job in creating public awareness. I do not know who would be filling that space in quite the same way if they were not there.
The three "Operation Transformation" experts are most important. I am sure Dr. Orsmond did not take Deputy Fitzpatrick's comments to heart when he used the old adage, "You have to be cruel to be kind", but, strangely enough, he was looking at her.
I think I speak for most, if not all, of the members when I say that the five "Operation Transformation" leaders, and those who went before them, have been the real heroes of all of this. I wish them good luck and that they would be at least members of that 80% who have stuck with it. I might have fallen by the wayside but they continue to give us that hope. I say well done.
Dr. Eva Orsmond:
I believe the weighing scales needs to become part of our lives. We need to start treating the cause, not the symptoms. We need to start educating people about food. It is lovely that we all agree that the leaders have done fantastic and they are the end result of our seven-point plan.
Ms Deirdre Halford:
"Operation Transformation" has changed my life in just a couple of weeks. I hope that, through these points that have been brought up, life can change for others as well. Small changes make a big change and if one adds all the small things up, it will make a big thing. Everyone can benefit from what all the experts proposed today.
Mr. Gavin Walker:
I back up the team. As Deputy Ó Caoláin stated, we have raised awareness. We brought the awareness out. It is out in the public now. Where we need to go from now is to the next step. We have presented the committee with a plan and, like Karl said, we would love to see one, two or three parts of that plan in force by the end of the year. It needs to be in force. I hope the committee has the power to do something about it.
Ms Monica Percy:
We can see all around the country the enthusiasm and the energy around following "Operation Transformation" and villages and towns all over Ireland walking every night. I would like to see it on a continuous basis, not just for the duration of the programme. I hope that in March and April people - children, adults, everyone - will still be marching on the roads at night-time, which they are doing now. It would be brilliant.
Mr. Gregg Starr:
I thank the committee for the opportunity to come here today. On the effect of "Operation Transformation", because I was part of a group last year and lost a great deal of weight, and then wanted to step it up to become a leader this year to continue my weight loss, we saw our group grow. We now have over 100 members. Twenty-four of them are under the age of 18, some as young as eight years of age. Some are heavy, some are not. Some are involved in it for the physical fitness and social side of it. We never discussed individuals' weight with them but what was discussed was how much they were losing per week.
With the younger children, especially, it became nearly a competition among themselves and they thrived on it. Obviously, the heavier children were losing a bit more and they were winning. The children loved it. They were focused, not on their weight but on how well they were doing each week because, as anyone who works with children will know, they do not have a very long attention span.
I help coach the under eights in rugby and I have seen children of all sizes and shapes coming to us. It is having an effect on them. Obviously, the first week they came down because they wanted to go on television, but we are getting increasing numbers of children in and getting them out running. It has just been fantastic. Even if they stop after "Operation Transformation" or if the group dies off, it is two months' exercise a year that they were not getting last year or the year before. Those are the little steps that might help if they can get into the 80% bracket further down the line.
Ms Charlotte O'Connell:
I am the youngest leader of "Operation Transformation" this year. I can see where they are coming from in terms of education because even in primary school, I was overweight. I knew that being overweight was an issue and the kind of embarrassment it caused in school. Weigh-ins should be introduced in school from infant classes upward. In my school, fifth class was the only class where a weigh-in was introduced. The teacher measured our weight and height. From fourth class onwards, I dreaded going into class because I knew she had that chart on the wall. If it was introduced in every class, used on a yearly basis and students knew it was used in every class, it would help. It needs to be carried out on an overall scale.
"Operation Transformation" has done much for my confidence. At 23, I did not want to discuss my weight with anybody. To see that I can come in here and talk about my weight, the effect it had on me and the changes that have taken place is tremendous.
On behalf of the committee, I thank the delegation for being here this morning. In reply to Dr. Murphy, we identified that this country had an issue with childhood obesity. We commissioned a report and held a series of meetings. Deputy Fitzpatrick is the rapporteur in respect of the report, which will be presented to the committee. The first step for us was to hold the hearings. The second was to invite the delegation to appear before us to recognise that what it is doing is not just connecting with the five leaders, but with the country and to raise awareness because it is critical. There is a recognition that there needs to be a cross-sectoral and multifaceted approach not just to childhood obesity, but obesity in general. The delegation will find that when we present our report, we will take further action and write to the Houses of the Oireachtas Commission regarding calorie counting here and see if we can move on that.
It is important to note that the story today is about the five leaders in particular, what they have done and who they represent. I also thank safefood for the work it does. I know it is involved in the programme but it also has been involved with us. I thank the delegation for appearing before the committee.