Dr. Sinead Murphy:

Yes. If I may, I will respond to a couple of the points that were made earlier about children and exercise. We know that less than half of children get the recommended amount of exercise. From a study that was recently done in our department, we know that less than half of the children who came to our clinic had an outdoor space to play in. If we are dealing with homelessness and tackling the homelessness issue, there is an option to look at this as well because the children have nowhere to go as they cannot go outside and play safely. I am not even talking about a back garden. I am talking about an outside public place to play.

For the second couple of cases that I described, we know that the children have established severe obesity and the behavioural model does not work. What we need is a primary care-led, integrated approach where all healthcare professionals are trained. Regardless of discipline, it is motivated healthcare professionals who are trained in motivating those families to bring about behavioural change and to manage in the obesogenic environment in which they live. That is what we need. We need investment and it must be primary care led and available in communities. Somebody mentioned children coming into hospitals, but that cannot happen. That is not a good way to deliver the solution. It was a public health nurse in the case I outlined but it could just as easily be a dietician. It may be a very interested GP. The healthcare profession does not matter. What is important is that it is a healthcare professional who is properly trained and in the right place so that when the children need the intervention, they can have it.

The other point that is really important is the measuring of children because by the time they look overweight, the horse has bolted and it is too late. Children need to be measured routinely. Perhaps we are a little bit better at commenting on their longitudinal height, but we tend not to measure weight and that should be part of every interaction with a healthcare professional.