Dáil debates

Tuesday, 22 November 2005

Priority Questions.

Obesity Related Diseases.

3:00 pm

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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Question 81: To ask the Tánaiste and Minister for Health and Children her views regarding the incidence of metabolic syndrome here; and if she will make a statement on the matter. [35724/05]

Photo of Seán PowerSeán Power (Kildare South, Fianna Fail)
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The Deputy is aware that the description of metabolic syndrome is of fairly recent origin, having first been described by Dr. Gerald Reaven in 1988. The syndrome has a set of risk factors, which include abdominal obesity; a decreased ability to process glucose, or insulin resistance; dyslipidemia, or unhealthy lipid levels; and hypertension. In a recent joint statement, the American Diabetes Association and the European Association for the Study of Diabetes questioned the diagnosis of metabolic syndrome. An editorial in this week's British Medical Journal noted that the debate on the existence of the syndrome will continue. The concept of metabolic syndrome provides a useful practical way for clinicians to identify patients with multiple factors which place them at a high risk of developing type 2 diabetes and cardiovascular disease. The concept also provides a rational basis for linking the actions in public health programmes like the cardiovascular strategy with the recommendations of the task force on obesity.

International literature has estimated that the prevalence of metabolic syndrome in the adult population of developed countries is between 22% and 39%, depending on the definition used and on ethnicity. There is not much information on the incidence of the syndrome. As there is no specific ICD code for metabolic syndrome in the ninth revision — clinical modification — of the international classification of diseases, it is not possible to state how many cases of metabolic syndrome are routinely identified and treated in Ireland. The prevalence of cardiovascular disease, type 2 diabetes and obesity is well documented, however. Some 39% of adults in Ireland are overweight and 18% are obese. Approximately 5% of the population is diabetic and over 40% of all deaths result from cardiovascular disease. It is well known that risk factors for these diseases are significantly inter-related.

Additional information not given on the floor of the House.

Lifestyle modifications are the primary interventions which help to reduce metabolic risk factors and manage short-term and long-term risk. Such lifestyle interventions include weight loss to achieve a desirable weight, defined as having a body mass index of less than 25 kg/m2; increased physical activity with a goal of at least 30 minutes of moderate intensity activity on most days of the week; and healthy food habits which include reduced intake of saturated fat and cholesterol.

The Government established the national task force on obesity in response to this country's obesity trends. The remit of the task force is to set out a strategic framework that identifies best practice for prevention, detection and treatment of overweight and obesity. The report of the task force, which was launched in May, makes 93 recommendations which relate to actions across six broad sectors: high-level government; education; social and community; health; food commodities, production and supply; and the physical environment. The report's main aim is to create a society that enables people to eat healthily and to be physically active. An implementation plan for the report is being developed by the Department of Health and Children's health promotion unit. Additional funding of €3 million has been made available to the HSE in the Book of Estimates to support the implementation of the report's recommendations. I would like to outline some of the key recommendations.

The report of the national obesity task force recommends that every child should be able to achieve a minimum of 30 minutes of dedicated physical activity every day, in all educational settings. As part of their school development planning, all schools should be encouraged to develop consistent policies to promote healthy eating and active living, with the necessary support from the Department of Education and Science. Such policies should address opportunities for physical activity and what is being provided in school meals. The report recommends that the Department of Arts, Sport and Tourism should co-ordinate with the Department of Education and Science the shared use of sports and physical activity facilities by schools and communities. Community skills-based programmes should be developed to provide skills such as food preparation, household budgeting and those which can promote physical activity. The health services, in their strategic planning and delivery, should advocate and lead a change in emphasis from the primacy of individual responsibility to environments which support healthy food choices and regular physical activity. An education and training programme for health professionals in the appropriate and sensitive management of overweight and obesity should be developed and implemented. Programmes should include training in developing life skills for healthy eating and active living and counselling.

The report of the task force recommends that the Departments of Enterprise, Trade and Employment and Health and Children, together with the private sector and consumer groups, should take multisectoral action on the marketing and advertising of products which contribute to weight gain, particularly those aimed at children. The Department of Agriculture and Food should review policies in partnership with other Departments to promote access to healthy food. Such policies should encompass positive discrimination in the provision of grants and funding to local industry in favour of healthy products. Guidelines for food and nutrition labelling should be reviewed to ensure labelling is accurate, consistent, user-friendly and contains information on portion sizes and nutrient content. The Department of the Environment, Heritage and Local Government should develop coherent planning policies for urban and rural housing, transport, amenity spaces and workplace settings to encourage spontaneous increases in physical activity in adults and children. The task force also recommended that the Irish Financial Services Regulatory Authority should examine the high costs of public liability and their impact on physical activity and should foster initiatives to address such costs.

A new campaign, Every Step Counts — Small Changes Make the Difference, which was developed in 2004 in response to the increase in the levels of overweight and obesity, promoted two main lifestyle areas — healthy eating and regular physical activity. The 2005 campaign, which is due to be launched later this month, will focus on promoting physical activity and the consumption of five portions of fruit and vegetables daily. The health promotion unit of the Department of Health and Children is also developing a national nutrition policy. It is envisaged that the policy will provide strategic direction on nutrition for the next five to ten years. The policy's target group is young people under the age of 18 and its priority actions are obesity and food poverty. A national consultation has taken place and the policy is due to be published early in 2006.

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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I am glad the Minister of State has accepted that the background conditions which cause metabolic syndrome are a greater threat to public health than smoking was at the height of its popularity. What does he consider to be the best approach to dealing with the four core elements of the syndrome, which are hypertension, high levels of cholesterol, a body mass index of more than the suggested level and diabetes? Does the Minister of State agree that prevention is better than cure? Does he accept there is a need to implement a screening programme at primary care level as the best way of dealing with this? The cardiovascular strategy that was mentioned by the Minister of State is not relevant in this regard, because most of it focusses on the Heartwatch programme, which is a form of secondary prevention. In other words, one cannot be dealt with under the programme unless one has had a heart attack or something like it. Are there are any plans to introduce primary screening in this area? The four main elements of metabolic syndrome — blood pressure, high cholesterol levels, obesity and diabetes — are going out of control, more or less, among the general population. We should introduce screening programmes in such areas, rather than waiting for problems to develop.

Photo of Seán PowerSeán Power (Kildare South, Fianna Fail)
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I agree that prevention is better than cure. Lifestyle modifications, such as weight loss to achieve a desirable weight, increased physical activity among young and old people and healthy food habits including reduced intake of saturated fat and cholesterol are the primary means of intervening to manage long-term and short-term metabolic risk factors. The report of the task force on obesity, which contained over 90 recommendations, was published earlier this year. The recommendations do not all relate to the work of the Department of Health and Children, as some of them relate to other Departments and agencies. Some €3 million was allocated in the Book of Estimates last week for the implementation of the report's recommendations. The Department will present its plan for the implementation of the recommendations shortly. I am aware of the significance and importance of dealing at an early stage with the problem of obesity, which has been described by the World Health Organisation as an epidemic. The evident increase in obesity in Ireland is another example of an unfortunate problem that has accompanied this country's increased affluence. Hospitals have reported cases of teenagers developing type 2 diabetes, which is normally associated with older people.

Photo of John GormleyJohn Gormley (Dublin South East, Green Party)
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They are doing no exercise.

Photo of Seán PowerSeán Power (Kildare South, Fianna Fail)
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That is what it is.

Photo of John GormleyJohn Gormley (Dublin South East, Green Party)
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We need to get them on their bikes.

Photo of Seán PowerSeán Power (Kildare South, Fianna Fail)
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We are trying to create a society that encourages people to eat healthily and be physically active. The Government intends to take a number of measures to bring that about.

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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Is it fair to suggest that the Government has given a lukewarm reception to the proposal to introduce a screening programme in this regard? It has given a similarly lukewarm reception to the breast cancer screening programme, which is being rolled out very slowly, and an even more lukewarm reception to the cervical cancer screening programme. Does the Government have any regard at all for the proposal to screen for diseases of this nature within the health care system?

Photo of Seán PowerSeán Power (Kildare South, Fianna Fail)
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The Deputy expanded on his question to cover a number of areas. From his side of the fence, our reception to the idea of the provision of such screening programmes might appear lukewarm, but we are serious about the policies we are implementing.

Some people have been critical of the Government for not dealing with the issue of obesity in the past, but last week it put its money where its mouth is. A sum of €3 million was provided in the Estimates to roll out our fight against the problem of obesity next year, an issue on which we have been working.

We will examine the provision of the screening programme to which the Deputy referred, if we consider it would be of benefit. I am not sure it would be, and I would not like to comment on it other than to say I will have the Deputy's suggestion examined and report back to him on it.