James Reilly (Dublin North, Fine Gael)

I welcome the opportunity to speak on this subject, in which I have had much interest over the years. I presented a paper on the policy that should be followed at the World Medical Association which was adopted in 88 countries.

The Minister of State has outlined the importance of obesity in regard to the nation's health. It is a major public health problem and it has been described as a global epidemic. The issue for this country is that the prevalence of overweight and obesity is higher than in almost all other countries in the EU. We are not winning the battle. At one of the many talks on obesity I attended, I saw a frightening electronic map of the United States which begins in the 1960s and, as the incidence of obesity goes over 25% in each state, the state turns red on the map. The map went from having just two red states in the 1960s to the entire United States being marked red some years ago. There are many trends in the United States which we follow but this is certainly one we do not wish to follow.

Children are of particular concern, and the increasing level of obesity in children is of major concern. This is multi-factorial in terms of the way Irish society is organised now and the way we worry about our children. I was in Dublin recently to launch a book for Monica Breslin. Much of it related to her time as a child living in Ballyboughal, when she could go down the fields to play — I have similar memories myself. If a child did not come back for lunch, nobody was particularly concerned whereas, nowadays, if a child is out of sight for more than 30 minutes, parents are extremely concerned. The opportunity for children to have opportunistic exercise is being continually limited by the way we fear for their safety, by the manner in which schoolyards are supervised and through concerns about insurance, for example, if a child falls, the school may be sued, as well as concerns around the safety of walking or cycling to school versus being brought by car. There is also the terrible situation where 75% of primary schools have no indoor sports facilities.

Other statistics are available to us from the Irish Universities Nutrition Alliance which suggest there could be more than 300,000 overweight and obese children in Ireland and the number is increasing by 10,000 annually. The increasing longevity we have seen in the past decade is multi-factorial. It has much to do with vaccination, improved living conditions and housing, safer food and cleaner water, and a little to do with our health service, but nothing to do with overcrowded wards, accident and emergency units and outpatient departments. Despite all that, in stark terms, we could be the first generation to bury our children in numbers. With the rise in obesity will come a rise in diabetes and with that will come not an increase in longevity but a decrease.

This is a major problem for our society and a major epidemiological issue that has to be addressed. I put it to the Minister of State that it is not being addressed in the manner in which it should be. While I accept the Minister of State is not long in her job and, therefore, we cannot point the finger at her, the Government has been extremely tardy in its approach, an issue I will deal with shortly.

A Department of Health and Children-HSE survey carried out in 2008 as part of the WHO childhood obesity surveillance initiative found that 22% of seven-year olds were overweight or obese — 26% of girls and 18% of boys. I have already outlined the major issue this brings with it, namely, diabetes, but there are many other problems. It signals increased risk of other problems such as psychological difficulties due mainly to widespread prejudice against fat people. We know children can be very unkind to each other but there is prejudice even in the workplace. The health consequences of obesity range from a number of non-fatal complaints such as respiratory difficulties, musculoskeletal problems, such as osteoarthritis of knees, hips and ankles, skin problems and infertility to complaints that increase the risk of premature death, including diabetes, gall bladder disease, cancers and cardiovascular problems. From other statistics, I know 10,000 people have died from stroke, so hypertension and high blood pressure, which is directly related in most cases to one's body weight, is a huge predictor for stroke and heart attack. For men, the incidence of erectile dysfunction increases as one's body mass index increases. The impact on our health service is grossly under-estimated, although we have some figures.

The psycho-social problems of the stigma and prejudice against people seems to border on the socially acceptable in Ireland. As the task force on obesity points out, the damage this causes to the welfare of citizens is extremely serious and, for this reason, Government intervention is necessary and warranted.

The direct and indirect costs associated with obesity are estimated at approximately €400 million annually. My view is that this is a major underestimate because diabetes alone last year cost this country €800 million and much diabetes is related to obesity and being overweight, although not all of it, and type 1 diabetes has nothing to do with it. Nonetheless, the huge increase we have seen in diabetes has much to do with it. This is before one begins counting the cost in terms of osteoarthritis, cancer of the stomach and bowel and many other medical conditions that put people in hospital. The cost of treating the consequences of obesity, according to the task force, was €70 million in 2002 — eight years ago — which includes the cost of GP consultations, hospitals contracts and prescriptions. The cost of inpatient treatment was €30 million in 2003 — seven years ago. These figures are grossly out of date, if the House will pardon the use of that term.

The indirect costs associated with obesity include workplace costs through days lost due to illness arising from obesity and, for those who are obese, possibly lower wages because of discrimination arising from their obesity. Finally, there are output losses due to output foregone as a result of premature death. We have no reasonable estimates of this. For England, the Auditor General estimated the total indirect costs at £2.6 billion back in 1998. On a pro rata basis, and allowing for increased costs since, this would place the indirect costs at some €370 million, according to the task force. As the Minister of State noted, the number of premature deaths annually attributable to obesity is approximately 2,000.

The national task force on obesity was set up by the Government in 2005. It aimed to provide the policy framework for addressing the high prevalence and rising levels of overweight and obesity, in particular childhood obesity, in Ireland. The report provided 93 recommendations for action, aimed at six sectors. The Minister of State has outlined those sectors. She used words such as "partially" and "somewhat". I have referred to the health sector part of the document which refers to significant progress in supporting healthy eating in the population. It may be significant progress by someone's measure but the bottom line is it has not been implemented. It states the health services should recognise the maintenance of a healthy weight as being an important health issue and measurement of height, weight, circumference and body mass index should be part of routine clinical practice in primary care and in hospitals. It states this has been partly implemented but this means, in other words, it has not been implemented. I will not have time to list all the recommendations. Out of 93 recommendations, less than 20% have been implemented. The year 2005 was during the height of the Celtic tiger. At a time when we could build 350,000 houses and 15,000 extra hotel bedrooms we did not need, we could not manage more than a one-fifth implementation to deal with a national problem that will involve significant financial and, very sadly, significant personal loss for people. If there were a need for another metaphor for this Government's priorities, this is it.

The programme for Government proposed a personal health check. It stated:

We will develop a freely available and personalised national programme to provide for the prevention and early detection of illnesses for both men and women. This will be called the Personal Health Check.

It lists points, but the bottom line is not alone has it not been implemented but it was dropped from the programme in 2009.

It is an integral part of the Fine Gael health policy, Fair Care, to have a national body test, and an age-appropriate annual checkup for every man, woman and child, for the very reasons I have highlighted. Diabetes is an illness that exemplifies this in a significant way. A national body test would identify people who are obese. Many people attend my clinic because they know of my interest in obesity. I check every patient's weight. At least 50% of the people who are obese thought they had just a bit of a weight problem. Once they got over the initial insult of the descriptive word "obese", they began to understand it as a medical condition which tripled their chances of premature death, stroke, heart attack, diabetes and a myriad of other things. At least they were taking the first step to recovery; they knew they had a problem because prior to that they did not think they had a problem.

For every patient diagnosed with diabetes, there is another patient in the community who has not been diagnosed and they will present late with complications relating to their eyes, kidneys, cardiovascular system and heart. I take this opportunity to advise anyone with diabetes that diabetes mixed with smoking means certain amputation of a limb. The two together are a toxic combination.

If there was true commitment on the part of the Government, we would have a national body test and a personal health check. These illnesses could be detected which would save many people a lot of suffering and save the State a lot of money.

The emphasis should be on prevention. However, we need to provide treatment for those who are grossly obese, on foot of a proper medical assessment. Only one place in the country, Loughlinstown, undertakes this treatment and the list is very long. Consequently, many people go to the United Kingdom and to Europe for these surgical procedures. Unfortunately, some suffer severe complications and consequences and there has been one death.

In 2008, the Commission on Patient Safety and Quality Assurance report, Building a Culture of Patient Safety, recommended the introduction of a licensing system for all health services whether they are delivered publicly or privately. To date this has not happened. The lady from Wicklow died in a private clinic in south Dublin.

Nothing has been done to implement the national nutrition policy. In November 2005, Deputy Seán Power, the then Minister of State at the Department of Health and Children, promised the policy would be published early in 2006. In February 2008, the Taoiseach, Deputy Brian Cowen, said it would be published "in the coming months". Two months later, the former Minister of State and Deputy, Pat the Cope Gallagher, said it was "in the final stages" of development, and his successor in the Department, Deputy Mary Wallace, who is in the Chamber today, said in May that year it would be published "later this year". In June 2009, the Department said the policy would be published by September. We are still awaiting same.

The Department of Education and Science has a significant role to play in changing the ethos with regard to school yard supervision to allow children to run freely, to avail of opportunistic exercise, in conjunction with and in addition to, physical education classes. I raised the issue that 75% of primary schools have no indoor exercise facilities even though these are essential in our climate. The Department needs to allocate more time to allow for the teaching of nutrition and good cookery habits.

I have a list of recommendations which should be implemented. The Minister for Health and Children was recently asked by way of a parliamentary question the amount of funding provided to tackle obesity over the past five years. She could not provide an answer because of industrial action in the Department. She was also asked if there would be a new policy for providing exercise facilities. There was no reply as this is a policy decision.

Vending machines in schools should dispense fruit. We need an investment programme for the provision of indoor facilities in primary schools, in particular. This could benefit the broader community as these facilities could be used after school hours.

I recommend the introduction of comprehensive food labelling information. I suggest the traffic lights system, with green for safe, healthy food, amber for food to be taken in moderation and red for food to be taken only in small amounts. The food industry may object to such designations but the health of our people and the health of our children is more important. The calorie content of alcoholic drinks needs to be clearly displayed. There should be no advertising of fast food before the watershed hour of 10 p.m. We know that billions of euro are spent on advertising because advertising works. Years ago, my younger son always wanted to go to McDonald's. He would not eat the stuff but he wanted to be there because he saw it on television. The national body test should be introduced as a priority. The Government policy regarding running in the school yard should be clarified. If there is a need to change the legislation with regard to possible litigation, this should be done.

See this speech in context