Dáil debates

Thursday, 1 April 2010

2:00 am

Photo of Áine BradyÁine Brady (Kildare North, Fianna Fail)
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I thank the Ceann Comhairle and Deputies for giving me this opportunity to make a statement on the subject of obesity. Obesity is a major public health problem internationally and is described by the World Health Organisation as a global epidemic. It is becoming one of the fastest growing health problems in Ireland. It is a complex condition that affects and threatens to overwhelm virtually all ages and socio-economic groups. Body weight reflects nutrition and physical activity and is a key risk factor for cardiovascular disease and diabetes. The prevalence of the state of being overweight and obese is high in Ireland and it is increasing.

The most recent survey of lifestyles, attitude and nutrition, the Slán 2007 report, indicated that 38% of the population in Ireland were overweight and further 23% were obese. Essentially, therefore, two-thirds of the population were either overweight or obese. These figures are broadly similar to rates in England and Scotland, and approximately 5% lower than rates in the USA. Findings from the Slán 2007 report also demonstrated that the trend in obesity was greatest in the lower socio-economic groups. The best estimate of change in adult body weight over time is a comparison of the Slán 2007 report with the 1999 North/South Ireland Food Consumption Survey. This has indicated that the percentage of the population that is overweight or obese has risen from 57% to 61% in less than a decade.

Among children there is also evidence of increasing obesity. The latest data taken from the Irish component of the World Health Organisation childhood health growth surveillance initiative found that, overall, 26% of seven year old girls were overweight or obese with a corresponding figure of 18% for boys.

The Slán 2007 report also found evidence of over-consumption of foods high in fats and sugar, such as oils, butter, cakes and biscuits. On average, Irish adults consumed a little over seven daily servings of these types of food. According to the food pyramid, they should be used sparingly, that is, less than three servings daily.

People who are overweight or obese are at an increased risk of developing a chronic condition. For children who are overweight or obese before puberty, this reduces the average age at which non-communicable diseases become apparent and greatly increases the burden for individuals and the health services. While it must be acknowledged that there have been advances in recent years in tackling many chronic conditions, the fact that people are now living longer, together with the rise in obesity means that this progress is threatened. Information published by the Institute of Public Health earlier this year forecasts significant increases in coronary heart disease, stroke and diabetes as a result of smoking and high levels of obesity across the island of Ireland. It is estimated that obesity is responsible for approximately 2,000 premature deaths every year in Ireland. This reflects a burden not only for individuals and their families but also for the health services.

The national task force on obesity was established by the Department of Health and Children in 2004 as a direct response to the emerging problem of overweight and obesity. Its report, Obesity — the Policy Challenges, was published in 2005. The report's recommendations related to actions across six broad areas, namely, high level government, education, social and community, health, food and the physical environment. The recommendations highlighted the need for cross collaboration between all key stakeholders and real practical engagement with both the public and the private sectors.

An inter-sectoral group on obesity, comprising relevant Government Departments and key stakeholders, was established early in 2009 to oversee and monitor implementation of the task force recommendations. The inter-sectoral group published a report in April 2009, detailing progress on each of the recommendations. The examination by the group showed that significant progress was made in the case of 32% of the recommendations, partial implementation has occurred on 31%, and action is progressing on a further 28%, leaving only 9% where little progress was reported.

The report indicated that while significant progress had been made across all sectors, there is a continuing need for concerted action in order to halt the rise in obesity. The group also gave some consideration to key priority areas for action in the short to medium term. The overriding concern of the group was the need for concerted Government action, driven at the highest level, to ensure a consistent approach to the implementation of the task force's recommendations. Among the areas highlighted were: measures to increase physical activity among children; continued awareness programmes about the dangers of excessive consumption of foods high in fat, sugar and salt; increased control of the advertising and marketing of food and drinks aimed at children; improved training for health professionals in obesity prevention; and diagnosis and counselling for those at risk of obesity.

Since the April 2009 report a significant development has been the publication of the first national guidelines on physical activity and the accompanying "Get Ireland Active" website. This was considered a priority because the recent Slán survey indicated that only 40% of adults undertook regular physical activity while one in five were physically inactive. In children, the Health Behaviour in School-aged Children survey found that more than half of primary school-aged children in Ireland did not do the recommended level of physical activity. Based on best international practice, the guidelines specify the recommended levels of daily physical activity for people of all ages and abilities. There are a number of further initiatives which are ongoing and contributing to actions on obesity. For example, healthy eating guidelines have been developed for pre-schools and primary schools, and nutrition guidelines for hospitals have also issued.

On food labelling, the issue of a mandatory nutrition declaration is currently being considered in the context of the EU proposal for regulation on the provision of food information to consumers. This would mean the food business operator displays the food's energy value, the amount of fat, saturates, carbohydrates, sugars, proteins and salt. On the issue of marketing, my Department is working with the Broadcasting Authority of Ireland on revising and strengthening the nutritional elements of the children's advertising code with a view to restricting the advertising and marketing of unhealthy food aimed at children. The Department is also developing a nutrition policy which is due to be completed this year.

These measures will help to reduce consumption of foods high in fat, sugar and salt, as well as increasing physical activity among the populations. With regard to the inter-sectoral group on obesity, this work is currently being examined in the context of a wider review of policy in regard to lifestyle-related illnesses, to which obesity is a major contributory factor. Elements of this work will be also progressed in the forthcoming policy on cardiovascular disease which will be completed shortly.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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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.

Photo of Jan O'SullivanJan O'Sullivan (Limerick East, Labour)
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I welcome the opportunity to speak on this subject. I think we have somewhat of a graveyard shift in the Chamber today, this being the last debate before the Easter recess and following a debate about the banks in which there was significant interest from the media. I do not know if there will be much of an interest in this debate. Perhaps I should not refer to the graveyard shift because once one ends up in a graveyard, one does not stay obese for very long.

This is a serious issue but we can do something about it, even in these straitened financial circumstances. Many of the 93 recommendations in the task force on obesity report do not cost much money or perhaps none at all. Society can take practical steps to deal with the problem and to prevent its occurrence, which may not cost any money.

I refer to the importance of a cross-departmental and cross-societal approach to this issue. I find no fault with either the current or former Minister of State in terms of their commitment to this issue. The responsibility for addressing it goes beyond the Minister of State, Deputy Áine Brady, and her predecessor, Deputy Wallace, but there is no evidence to indicate that it is being addressed in a serious manner at all levels of Government. I would contrast us with Finland, which managed to reduce its obesity levels because it took the issue seriously.

The Minister of State described the current state of obesity and compared us to other countries. I would not clap myself on the back because we are not as bad as the United States, which offer the best example of how awful obesity levels can become. I recently spoke to a friend who had just returned from the US and attested to the enormous portions served in restaurants there. How much rather than what one eats makes the difference in terms of obesity.

We have to adopt a broader approach. The latest report of the intersectoral group, which issued in April 2009, indicated that just over 30% of its recommendations had been implemented, a further third had been partially implemented and a 25% were being progressed. I ask the Minister of State when the next report will issue because considerable progress remains to be made. Five of the recommendations are aimed at high levels of Government and a number of them pertain to Departments, particularly in regard to the physical environment and the education, social and community and health sectors. We will not be able to make progress unless we engage with the recommendations at that level. I urge the Minister of State to ensure the intersectoral group engages the recommendations with a view to implementing them.

We have to address this issue from birth onwards and there is even evidence to suggest that problems of obesity can first emerge at the prenatal stage. It is vital that all new mothers and fathers are brought into educational programmes, which could be initiated in maternity hospitals and continued in the community. It is an obvious point that everybody in the world was once a young child but it is often missed in our focus on the problems that have already developed by the time children are attending school. We should be aiming at preventing obesity. One person I heard speak on his issue argued that we have created an illness industry rather than a healthy living policy.

Deputy Reilly correctly pointed out that the incidence of chronic illnesses such as diabetes and heart disease could be significantly reduced by addressing the problem of obesity. This would allow us to save huge sums of money on health services. The Irish Medical Organisation has called for medium to long-term goals for reducing obesity levels because we will not see overnight results from preventive measures, a system for measuring expected health gains and the ring-fencing of funding so that it is not syphoned off for other programmes.

Serious issues arise for the Department of Education and Science in regard to physical education. On rainy days, many schools lack the facilities to provide physical activities and while it is on the curriculum in theory, it is not taught in practice. Looking at school photographs from 30 and 40 years ago, I was struck by the size of children compared to today. We must ensure that funding for physical education facilities is ring-fenced in the Department's capital budget. Schools which lack their own facilities have plenty of scope to engage with community and sporting organisations to ensure young children can access physical education. This can involve paying for children's transport and entry to facilities such as swimming pools. We need to think outside the box if these facilities cannot be immediately developed in schools.

The free year of preschool education offers an opportunity for the Government to insist on healthy eating programmes. The Minister of State referred to the guidelines for preschool facilities and hospitals but given that they are funded out of public money, why do we not insist on the promotion of healthy living?

Deputy Penrose has permitted me to reveal to the House that he has lost a considerable amount of weight by following the guidelines that were made available to him. He told me that the most important action is to step back from the table. While a considerable amount of information is available to the public on obesity, this in itself is not enough if we do not incorporate the societal measures to which I referred.

There is scope for ring-fencing revenue from taxes on alcohol and other products. We should connect these stick taxes directly to spending on positive measures to improve our lifestyles and make us more healthy. If we made such connections we would be better able to ringfence the funding we need for such programmes.

In her speech the Minister of State outlined specific measures which were also part of the recommendations of the task force. However, a narrow consideration of this matter from the point of view of the Department of Health and Children will not get the results we require. We need a high-level, cross-Government, cross-departmental approach to the issue. We must engage the public and present a positive public message to the effect that we are serious about the issue and that, even in a recession, we can start to achieve our ends. Other countries have done so but not within such a narrow focus. They have done with a broad societal focus and this is the direction in which we must go.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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According to the report Health in Ireland: Key Trends 2009, published on 1 December 2009 by the Department of Health and Children, "obesity in Ireland is now one of the major challenges which faces the health services into the future. In 2007, 59% of men and 41% of women self-reported as either being overweight or obese". This is a fairly stark statement and it needs to be taken very seriously but it requires qualification. Many people see being overweight or obese as a question of appearance and for some, it will always be no more than that. Some people may be marginally overweight and this may cause no health difficulties or unduly restrict them from living their lives to the full. However, for too many people — the number is increasing — obesity seriously impairs health and quality of life or threatens to do so in the future. Of particular concern is the rise in levels of obesity among young people and children. The position was well stated in the report of the Inquiry into Obesity conducted by the Committee for Health, Social Services and Public Safety in the Six County Assembly and published last October, with which the Minister of State may be familiar. In its introduction, that report states:

Obesity has been variously described to us as a 'well established epidemic', a 'tsunami', a 'crisis' and a 'population time bomb'. It is a problem that will have an enormous impact, not just on the health of the population, but something that threatens to engulf the entire health service and it will have a very serious impact on society and the economy. For many people obesity is seen primarily as a vanity or aesthetic issue. However, it has very serious and life-threatening health implications through a wide range of conditions, such as heart disease, type 2 diabetes, some forms of cancer, and high blood pressure. We were told that obesity could cause the present generation growing up to have a shorter life span than their parents.

All of this applies across the island of Ireland and is not unique to the six north-eastern counties of our country. We must take very careful note of the findings and recommendations of that report. Studies in the United States and elsewhere have shown a link between obesity and low income poverty. People on lower incomes in developed countries tend to have poorer diets in terms of quality, if not in quantity, with more junk food and less health-giving foods in their diets. Also, they have fewer opportunities for healthy leisure activities and fewer amenities to aid physical fitness. People on lower incomes are more likely to be smokers and to experience the adverse effects of abuse of alcohol and other drugs. Alcohol itself is a contributory factor to obesity.

Many respondents to the Assembly Inquiry into Obesity report from which I have cited highlighted the links between poverty and obesity. I refer to some examples. Action Cancer pointed to research which found that, "people on lower income have higher propensity for fast food diets and food with little nutritional value. Additionally, people with little disposable income are less motivated to engage in regular exercise due to the high costs associated with gyms or sports clubs". Dr. Colin Hamilton of the British Medical Association suggested that, "looking back 50 or 60 years, one discovers that obesity was not a working-class problem, but, rather, one of the middle and other classes — the people who had money to spend on food. Nowadays, the situation has totally reversed". John News of Sport Northern Ireland, agreed stating that, "the settings are important; not everyone wants to go to a council-owned leisure centre, but neither can everyone afford to go to a private health club or leisure centre. The health inequalities across Northern Ireland show a definite correlation between socio-economic status and participation in sport and physical activity".

The Public Health Alliance for the island of Ireland, with which we are all familiar, is an all-Ireland organisation which addresses health inequalities. It pointed to research undertaken in 2007 to examine the scope and extent of food poverty in the North of Ireland. That research concluded that, "there is strong evidence to indicate that people living in food poverty almost always have a diet which predisposes them to the risk of obesity". I refer to another example. Andrew Dougal, Northern Ireland Chest Heart and Stroke Association, has pointed out that success in preventing heart disease and stroke has been achieved in the higher socio-economic groups and while he agreed with the total-population approach he argued that, "there may be a need to focus on the more deprived groups in society to ensure that those people are empowered to change their lifestyles".

Andrea Marnoch, Food Standards Agency Northern Ireland, reported on the findings of the low income diet and nutrition survey, LIDNS, carried out between 2003 and 2005, and published in 2007. Its aim was to study material deprivation in the diets of what it called the bottom 15% of the population. It concluded that:

Compared with the general population, the low-income population was less likely to consume wholemeal bread and tended to consume more non-diet soft drinks, more processed meats, more whole milk and more table sugar. Consumption of fruit and vegetables fell well below the recommended level of five portions a day, and consumption of oily fish was very low.

While the rates of obesity have increased most among adults and children from poorer backgrounds, research has also found that the widening of obesity inequalities is more evident among women than men. The Fit Futures report in the North stated: "Higher rates of obesity have been found in adults, especially women, with mild to moderate learning disabilities that live in the community than in the general population". The Royal College of Psychiatrists reported that "people with mental illness and those with learning disabilities are more likely than the general population to be obese". It would useful to put on record a summary of the recommendations of that useful Assembly report, especially those that can be applied to this jurisdiction, most of which can. It recognises that obesity is the most serious and most challenging public health issue that we face at this time and it is also one of the most complex. There is, therefore, an urgent need to develop and implement a comprehensive and robust strategy to address the issue.

Growing levels of obesity will continue to generate enormous costs to society, particularly the health and social care sector in the years ahead. Given this and the potential for significant cost benefits, it is imperative that substantial and sustained resources are provided to implement a life course strategy, in other words, a strategy that addresses people's lives and health in the round to address obesity.

A joined-up approach is required across all Departments, public sector agencies, including local authorities, the private sector and the voluntary and community sectors to tackle obesity. There needs to be an audit of existing obesity-related initiatives so that the need for evaluation or further research can be identified and examples of good practice can be rolled out more widely.

There needs to be a range of evidence-based referral options for use by primary care practitioners. The Minister should undertake a comprehensive review of weight management services at all levels for adults and children. The review must address, for example, the need for dedicated obesity clinics. The review should also consider the merits of adopting examples of good practice from elsewhere, such as the Counterweight programme in Scotland and the Carnegie Weight Management programme in England. There is much that we can learn from international best practice. The problem is not unique to us; it is global, certainly in the developed Western society as we know it, and we can learn from the approaches employed in other jurisdictions.

The HSE and the Department of Health and Children should exert pressure at a national and European level to introduce regulatory controls on the levels of salt and saturated fat in manufactured foods. The Assembly report urged a single, consistent food labelling scheme and urged a system that could be made mandatory on all food retail products. It called for more action to enforce a similar, clear and simple nutrition labelling system at non-retail outlets such as restaurants, hotel and other catering establishments. Sinn Féin urges an all-Ireland approach to this aspect of food labelling and, indeed, to all food labelling.

While recognising the difficulty in regulating food portion sizes in catering and similar settings, we urge the Department to examine how issues such as food promotion and pricing impact on portion sizes, and how they might be influenced.

Significantly, the report recognised that there is confusion over what exactly constitutes five portions of fruit and vegetables daily, and particularly around the size and content of a portion. The Department and-or the HSE should examine how greater clarity and understanding about this health message can be achieved and how it might impact on levels of obesity.

Publicly provided sports and leisure facilities are vital in tackling obesity and overall health and fitness needs of the population. In some ways, the North is more advanced than this jurisdiction in that regard and much work needs to be done in the State in that area over the years ahead. Every Department should recognise that it has a crucial role to play in responding to the obesity epidemic, either through direct action or through policies and practices that impact on the factors that contribute to obesity.

We need to explore the feasibility of banning the advertising of food and drink products that are high in fat, salt or sugar before the 9 p.m. watershed. New and emerging media should also be used to engage with young people because they tend more to these new means of contact communication. Such media should be explored and opportunities identified in order to address more young people on the issues of health, fitness and obesity. Crucially, health inequalities must be recognised, and particularly the need to address the higher levels of obesity in areas of social deprivation.

It needs to be noted by so many across society that there are real benefits for both employers and employees in promoting healthy lifestyles in the workplace, and that employers have a role to play. They should consider initiatives, within or in association with the workplace, that promote healthy eating and greater levels of exercise.

The answers to all of the problems presented by obesity are at the end of the day relatively simple. The difficulty is getting everyone on board and signed on for the overall project of address of this major challenge that we face today and, ultimately, encouraging enough within society to recognise the importance of that address.

Photo of Jimmy DevinsJimmy Devins (Sligo-North Leitrim, Independent)
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I wish to share time with Deputy Mary Wallace.

I welcome this debate. I welcome the Minister of State, Deputy Brady, who has responsibility for obesity. Indeed, in her preamble, she outlined the frightening increase in obesity and its related dangers.

Urgent action needs to be taken. There is an epidemic of obesity sweeping the country. We can sit here and talk at length but, unfortunately, talking is not of any use at present. The following startling statistics, if put in front of the House, might clarify all our thoughts.

There are over 4,000 deaths every year in this country from obesity-related illnesses. If that was in any other sphere, for example, road traffic accidents, there would be justifiable public outrage. With 4,000 deaths every year from obesity-related illnesses, what are we doing about it?

Thirty years ago the weight of our children was average in comparison to those in Europe. Today, we have the fattest children in Europe. It is frightening. That is a time bomb which is building up and which will explode in all our faces, and particularly, unfortunately, in the health of our children as they mature into teenagers and young adults.

On a specific point, Professor Donal O'Shea, who was the medical adviser to "Operation Transformation" and is probably the leading weight-loss expert in the country, has a clinic in St. Colmcille's in Loughlinstown and St. Vincent's Hospital in Dublin. That, to my knowledge, is the only clinic trying to deal with the whole country. We need extra clinics.

I have been informed that the operations carried out for the morbidly obese, that is, those who are in severe danger of losing their lives due to obesity, have not been carried out since 1 January. There are approximately 400 of these operations needed every year in this country. I ask the Minister of State to inquire as to why there have been no operations carried out since January.

The task force to which she alluded is a good one. It has published over 90 recommendations. Significant progress has been made in respect of 30 of them, partial implementation has been achieved in respect of 29 and action is progressing on a further 26, leaving only eight where little progress was reported. Stripping away all the fine language, it means that out of 90 recommendations, there are approximately 30 on which there is decent progress being made. That is not good enough and it must be improved. It really is too easy to pay lip-service to this time bomb which is in our society.

I will outline briefly what I want to see done. We need action on two areas. The first of these is curative. For those who, unfortunately, have obesity-related problems, let us have a HSE clinic in each of the four HSE areas so that the load is spread all over the country. Second, we need an immediate resumption of the publicly-funded operations for those who need gastric by-passes.

On the preventative side, they say prevention is much better than cure and I would argue it will be cost neutral. First, let us all increase our exercise. Some of the Members who participated in "Operation Transformation" are present in the House. There is Deputy O'Dowd, who has——

Photo of Fergus O'DowdFergus O'Dowd (Louth, Fine Gael)
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Fades away.

Photo of Jimmy DevinsJimmy Devins (Sligo-North Leitrim, Independent)
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——done very well. Indeed, I want to pay tribute to all of my colleagues across all parties, both here and in the Seanad, who participated in it. We all agreed that exercise was the simplest, but most cost-effective, way to lose weight. Walking, or jogging for those who are younger, does not cost the State anything. Those who claim they cannot find the time, know well they can easily find it.

It would be wonderful to see a straightforward food labelling system with a green label for healthy foods, orange for those high in calories, and red for those to be avoided. Some argue it is more complicated than that but I believe it needs to be done.

Photo of Fergus O'DowdFergus O'Dowd (Louth, Fine Gael)
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Hear, hear.

Photo of Jimmy DevinsJimmy Devins (Sligo-North Leitrim, Independent)
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Another preventive measure is to begin weighing every schoolchild annually. The weigh-ins can be done either by the teachers or the public health nurse. Then a note can go back to each child's parents explaining their child's weight is normal or abnormal for their child's age and sex. If parents are made aware of a problem with their child's weight, they can take preventive action with assistance, if needed, from various health agencies.

The public has much interest in the obesity issue. Up to 500,000 people watched "Operation Transformation" every week on television while its webpage received over 3 million hits in eight weeks. This has never happened before to a programme on RTE. I pay tribute to the programme, in particular Gerry Ryan, and the experts who helped us when we participated in it. It brought home to me that there is an interest in both Houses of the Oireachtas in a cross-party and non-political approach to tackling obesity. We can all work together and not be scoring political points in tackling this and other such issues.

I pay tribute to Don Rice and his catering staff in the Houses of the Oireachtas for putting healthy options on the menu, the take-up of which has been tremendous. Why can every restaurant not do the same? Chefs are the experts in the caloric content of a meal and are well able to put one healthy option on every restaurant menu, allowing people to know a low-calorie meal is available when they eat out.

We do not need any more procrastination in tackling this issue. The public has a high interest in it. Action needs to be taken. The Minister of State, Deputy Áine Brady, is the right person to do it. I look forward to her leading the charge. Some high profile exercising events lead by the Minister of State and celebrities should show most exercise can be done for free.

Photo of Mary WallaceMary Wallace (Meath East, Fianna Fail)
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I thank Deputy Devins for sharing his time with me. I support the Minister of State, Deputy Áine Brady, in her work in this area. All Members across the House agree tackling obesity must be prioritised. The statistics are frightening with 38% of the population overweight and 23% obese, a total of 61% of the population in the overweight-obese category, a rise from 57% in just a decade. This epidemic needs to be halted.

Action is required in promoting good nutrition and physical activity. We must make it easier for people to make healthy choices. Yesterday I heard one advertisement from the Little Steps campaign on radio in which a man takes his kids for a walk instead of going to the pub. The Little Steps programme has a good television and radio advertising campaign.

Obesity among children is also a concern with associated chronic health conditions such as type 2 diabetes and cardiovascular diseases on the rise. More than half of primary schoolchildren do not get their recommended daily level of physical activity. Is this a school or family issue? That children spend 20% of their time in school means it is a family issue.

The change of school vending machine products to healthier options is important. A year ago the Department of Education and Science wrote to all schools on this matter. Will the Minister of State follow this up to establish what progress has been made?

Changes were made to the food served in the canteen in Leinster House for which I commend Don Rice and his staff. I hope it can happen in other workplace canteens across the country.

When I was Minister of State with responsibility for tackling obesity, I was impressed during my visits to Professor Donal O'Shea's clinic in Loughlinstown. The Minister of State should visit it to see the outstanding work done there. While it is serious when people get to the stage they must attend the clinic, there was a proposal to develop other units across the country. I hope this is still on course as it will be important in treating obesity.

More parents practise what they preach when it comes to family health. A recent survey showed 65% of children walk to their destinations, other than to school, in a typical week, a rise of 59%. Little steps go a long way but the battle is far from over. Individuals are responsible for their lifestyle choices but we can make it easier for them to lead healthier lives.

With over 61% of the population in the overweight-obese category, tackling obesity must be priority. I wish the Minister of State well in her work in halting this epidemic.

Photo of Olwyn EnrightOlwyn Enright (Laois-Offaly, Fine Gael)
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I wish to share time with Deputy O'Dowd.

Photo of Joe CostelloJoe Costello (Dublin Central, Labour)
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Is that agreed? Agreed.

Photo of Olwyn EnrightOlwyn Enright (Laois-Offaly, Fine Gael)
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While many other important issues had to be debated in the last while, obesity, which was given much attention several years ago, seemed to have dropped off the radar. It is a serious issue with long-term health and cost implications for the country.

It is welcome that Deputy Áine Brady is the Minister with responsibility for this area. It is the victim of a lack of joined-up government because it falls between many different Departments. Much mention has been made of the responsibilities of Departments of Health and Children and Education and Science. I believe, however, the Department of Agriculture, Fisheries and Food has a responsibility too. Ireland has a strong agricultural sector producing healthy food products. People need to be made more aware of these and the role they can play in a healthy lifestyle. The new Department of Social Protection also has a role to play because of the higher incidence of obesity in areas of social deprivation. Less healthy foodstuffs also tend to be more expensive which compounds the difficulty.

Obesity has to be tackled in a holistic manner. It is easy to say responsibility for it should rest with schools. The primary responsibility, however, should be in the home. For that to happen we must examine how we get the message into the home.

The first port of call should be the public health nurse. They will be loathe to hear that I suggested they should have any more on their plates because they are already very busy. From my experience, I have found them to be well-qualified and good at imparting information to parents. Their first visit to a home is a good opportunity for them to instil in families the importance of healthy eating and lifestyles. The primary care centres are another good local point where facilities and information on healthy lifestyles and qualified personnel should be available.

I do not want to overload what must be done in schools because there is not much time. I question the PE programme in schools and I question the ability of primary schools in particular to deliver it. I recently had a conversation about how little PE there was when we were in school. That has improved dramatically but there are differences between schools, particularly between girls schools where there is not the same emphasis on competitive sports, which leads to less emphasis on all sports. If one is not good at sports, one is not picked because schools are in competition. That causes difficulty for children's participation and needs to be addressed.

Deputy Wallace referred to vending machines in schools. They should not be there. I remember visiting a public-private partnership school in Munster and being shocked because the school looked like McDonald's. The colouring and signage in the canteen area was like McDonald's. This should be outlawed in schools so that only healthy choices are available. A very good example of this is in Clondalkin, where two teachers took it upon themselves to drive this matter. There is a voucher system in place, with vouchers given to everyone to ensure there is no social stigma. It works very well and could be replicated.

I support labelling. I refer to Deputy Devins's comments on the school weigh-in. I agree with the sentiment but I have concerns about doing it in school. School is a very competitive environment and I have serious worries for children in general, and particularly young girls, about having this done in school when children will ask one another afterwards how they got on and where issues of bullying are rife. This could add to the difficulties experienced in schools.

I refer to the opposite of what we are talking about, eating disorders. When talking about obesity, we must be conscious that we do not make it seem that being skinny is the appropriate direction in which to go. It is about a healthy lifestyle. There is a chronic lack of bed capacity in this country for those who are obese and those who have eating disorders such as anorexia and bulimia. There are three beds in the entire country for people with anorexia or bulimia; this matter must be addressed.

Photo of Fergus O'DowdFergus O'Dowd (Louth, Fine Gael)
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I welcome my niece, Alana O'Dowd, who is in the Distinguished Visitors Gallery. She flew overnight from New York to be here and has not slept. She came here with my brother Niall.

Photo of Paul Connaughton  SnrPaul Connaughton Snr (Galway East, Fine Gael)
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Especially to hear Deputy O'Dowd's speech.

Photo of Fergus O'DowdFergus O'Dowd (Louth, Fine Gael)
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Especially to hear me. She is awake. Her uncle — that is me — was 19 stone and now I am the right side of 15 stone and 6 lbs. The reason for this is Operation Transformation. I proudly hold my certificate, signed by Senator David Norris and Gerry Ryan. I am lucky, I am here and I have done it. I just have to keep off the weight. I was obese and I am now overweight and I must reduce my weight further. The key message I want to give to Alana and everyone else is that it is all in our minds. It is a case of making up one's mind that one is going to change. Going on a diet does not make sense because that suggests I will go back to the way I was before I lost weight. I am not going back there. One must change what one does. The job of the State is to aid and assist that through the Department of Education and Science and the Department of Health and Children.

I am convinced the answer lies in the fact that everyone watches television and sees people they like and know and they want to see if they have changed on Operation Transformation. A cross-party group of Deputies and Senators, along with taxi drivers from Galway and mothers from Louth and Meath, competed against each other to lose weight. We all won because we lost weight. We are all feeling much better as a result. Let us carry that forward in our public broadcasting policy. It is a simple issue that RTE has addressed successfully but it needs to continue. The key to Operation Transformation was the reaction from the community. Mothers in particular talked about losing weight and how to do it. My message is that if I can do it, anyone can do it. It is a matter of making up one's mind to do it. The supports are very important but the message must continue to go through RTE, broadcasting and radio stations.

I agree with my colleague Deputy Devins. Let us get the food interests together and agree that we will make food that is right and good for our bodies. If we produce and sell food that is not good for us, we should change our ways. We should put up the red light if there is too much fat in those foods. We need a small amount of fat as part of our diet. The system should be such that green is good, if it is orange we must think about it and if it is red we must be very careful. There are rows and rows of supermarket shelves full of soft drinks and crisps. This would disappear overnight or at least get smaller if everyone — regardless of education, background or size — understood that if it is green one goes there, if it is orange one goes there occasionally and if it is red one seldom goes there. Putting anything else on food packaging makes little sense because people will not understand it.

The message is clear that we will live longer, healthier lives. Exercise is the key. I cannot believe that in the past three months I have been rollerskating, skating, running and walking. I have been doing just about everything. The only other thing I want to do is chase this Government out of office and I am happy to do so, beginning with Deputy Seán Connick.

Photo of Paul Connaughton  SnrPaul Connaughton Snr (Galway East, Fine Gael)
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Deputy O'Dowd should do some canvassing.

Photo of Fergus O'DowdFergus O'Dowd (Louth, Fine Gael)
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I am delivering leaflets and there is no better or fitter man than me. It is all about changing ourselves. This is an important policy debate. It involves everyone together. If I can do it, anyone can do it so let us all get together, push it as a policy, put it on the agenda in the general election and we will all sign off on it. Let us do it and our country will be better as a result.

Photo of Seán ConnickSeán Connick (Wexford, Fianna Fail)
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I am delighted to make my contribution to this debate, picking up where Deputy Fergus O'Dowd left off. We were all participants in Operation Transformation. I lost 20 lbs during the programme but I have lost approximately two stone at this stage. Last Christmas I was sitting at home thinking I was unfit and unhealthy. I was not feeling great and I had a medical checkup. I decided I would become fitter and it goes to show that with commitment and a little effort this can be achieved.

I came from a fitness background, having been in the industry for 14 years running a health club with my wife in New Ross. I was very conscious of the effort people make in trying to lose weight. It is a huge industry. Everybody is body wise and has difficulties with how he or she looks or is perceived. It is a massive industry and people are searching for solutions. The success of Operation Transformation was to mobilise the nation. In recent years it was on the national airwaves and people were watching it but this year, because of the involvement of outside groups, it took on a greater focus and momentum. I congratulate Gerry Ryan and his team on their efforts. I am not sure they thought the politicians would do as well as we did. We lost almost 27 stones among 15 people. This is a phenomenal amount of weight, if one imagines it as 27 one-stone bags of potatoes. That is a lot of weight among 15 people of mixed abilities, age groups and backgrounds. As I travelled around the country, it was an issue everywhere. Everyone wanted to know about Operation Transformation and it took the focus away from the economy and other things. The bottom line was how much we had lost each week and whether we had seen Gerry Ryan. There was a serious message being sent out and this message got through to many people. Deputy O'Dowd made the point that it is important to carry on this effort. I continue to exercise. Being appointed as Minister of State, which means being located on the fifth floor of Agriculture House, is very helpful because in the past few days I have been up and down Kildare Street non-stop. It is just as well my fitness levels had increased before I was appointed.

We are speaking in the context of two out of three Irish adults being an unhealthy weight, with almost 25% of people obese. This suggests that almost 60,000 Irish people could be medically eligible for weight loss surgery, a shocking figure. The figures concerning the banks are shocking, such as the €8 billion pumped into Anglo Irish Bank. Some 2,000 premature deaths were caused by diseases related to obesity. It cost the State more than €4 billion each year. That is half the amount we are putting into Anglo Irish Bank.

Photo of Paul Connaughton  SnrPaul Connaughton Snr (Galway East, Fine Gael)
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It is one-quarter of what the Government will have to put into that bank.

Photo of Seán ConnickSeán Connick (Wexford, Fianna Fail)
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I am putting in context the scale of the amount involved and the impact it has in this area.

I want now to return to the healthy lifestyle we enjoyed as children although I accept that life was different then. When I was growing up in the 1970s and 1980s in most cases there was a parent at home which meant one enjoyed a balanced diet and regular meals on the table. Much of this has been replaced by pizza and processed foods which contain lots of salts and fats. There is a huge personal responsibility on each of us as citizens and parents to try to educate ourselves and our children in regard to having a healthy lifestyle.

While I do not like to refer to the young people of this generation as the "playstation or Xbox generation" that is to a large degree who they are. The Government has during the past number of years invested hugely in facilities such as sports halls and public spaces in terms of playgrounds, including playgrounds for older people, which is to be welcomed. We need to continue to encourage children to use them. I am conscious of the success of the schools' Green Flag programme, which is a good idea. We should perhaps consider the introduction of a healthwise flag which would encourage children at school to opt for a healthy lifestyle in terms of exercise and food.

I met on Tuesday in my new role as Minister of State with responsibility for fisheries with the fishermen groups and was shocked to hear from one fisherman that 120 boxes of white fish had been dumped at port this week because there was no market for it, which is incredible. I made the point that it would have been better had they bagged it and given to schoolchildren in the area to bring home. Fish is a healthy option which is available in our ports but there is no market for it. We need to increase the amount of fish we consume. Likewise we need to encourage people to use our public parks.

Deputy O'Sullivan referred earlier to obesity levels and food menus in America. I travelled Route 66 last summer and as such I spent almost three weeks driving across America. I had a very interesting experience in terms of food portion sizes and access to public spaces. Often environmental issues in Ireland take precedence over people. I got the impression while in America that people come first and then the environment. America is the first country I have visited where I could wheel on the beach. I could do this because they had constructed on the beach a two or three metre wide concrete path which ran for 20 miles along a beach in Los Angeles. Under normal circumstances, one cannot access the beaches. There would be uproar in Ireland if we tried to construct concrete paths on any of the beaches here. We must examine how we can encourage people to use our outdoor facilities, of which we have many.

We need to also examine the size of our food portions. I was delighted to hear that the Irish Hotel Federation recently issued a food for kids programme which is to be introduced at its hotels. This is extremely important. When we were growing up we did not get to go to many hotels. When one goes to a hotel these days it is chips and sausages or chips and nuggets rather than a half portion of dinner that is listed as the children's menu. Years ago, when one went to a hotel for dinner it was possible for children to get a half portion of what the adults were having. This should be reintroduced. We should also consider the introduction of healthy options menus, which are more profitable. Members will be aware of the success of the "Operation Transformation" menu in the self service canteen. Unless one goes in early in the evening, the OT options are gone. People want to eat healthier. There is more we can do, including ensuring the availability of low fat milk and Benecols and so on, which are vitally important to us.

In Ireland, if one asks for a sandwich one usually gets a sandwich, half a plate of coleslaw and a bag of crisps so that instead of having a snack of 300 calories one has a snack of 1,200 calories. We need to be mindful of this and that exercise is key. When I started the exercise campaign ten or 11 weeks ago I could swim 20 lengths of the 25 metre swimming pool in approximately one hour. I can now swim 40 lengths, which is a kilometre, in 40 minutes, because my fitness level has improved. I also push two miles and cycle for one hour two or three days a week. I exercise seven days a week. The key to losing weight is to reduce one's portion size, reduce the level of fat intake in one's diet and to exercise. If I can do it, anybody can do it. It was amazing to watch the 15 people cross-party take on the challenge and succeed.

I welcome the multi-sectoral approach to this across all Departments. I acknowledge the huge amount of funding invested in facilities throughout the country. I agree with the previous speaker in regard to the traffic light scheme. I believe supermarkets have an opportunity to go ahead of the industry in terms of using the red-orange-green light system in their aisles. One can eat products from the red aisle but cannot eat too many of them. Many of us who visit families and relations will know of the "shop in the press", which usually contains Twirls, KitKat and bags of crisps. This is often in our own homes too. There is probably one in every house. We need to be mindful of this and try to encourage people to eat healthier. I believe the first supermarket to use the red-orange-green light system in its aisles will be credited for doing so and will see a huge uptake in people shopping there.

We, as consumers, have the power to change the industry. Coca-Cola, McDonalds and Tayto are three major companies. McDonalds has and continues to change its menu to meet consumer demand. However, we as consumers ultimately have the power to change the industry. If we continue to choose the healthier option we will force their hands in terms of changing their products. "Operation Transformation" was a huge success — it has received a great deal of mention here today — and we should perhaps as a Government and a nation consider running, through the media and this House, a national campaign in the form of "Operation Transformation" which could perhaps be called "Mobilising the Nation" and would assist in encouraging people to get fit and stay healthy thus reducing the costs on our health service. We all have a personal responsibility in this regard.

The issue of children running in schoolyards and compensation claims and so on was mentioned earlier. We are to blame for some of this. We must ensure schools are not sued if children are hurt playing football or have fallen when running home from school in the evening. We must consider putting in place safe walkways and cycle lanes for school children. These are not huge cost options but are actions that could be taken as soon as possible. I commend the Minister of State for bringing this motion before the House and for giving us the time to contribute to it.

Photo of Paul Connaughton  SnrPaul Connaughton Snr (Galway East, Fine Gael)
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I congratulate Deputy Connick on his appointment. I hope he does well in that office, in which I spent five years as Minister of State some time ago.

I wish in my contribution to move away from what has been said already. When I hear the word "obesity" I think of a killer of people, a destroyer of self-esteem and a robber of scarce Exchequer resources. There is no bigger health issue. There are disturbing trends emerging in terms of obesity. This is happening against the wishes and will of people who are doing their level best not to go that route.

Obesity is causing us huge problems. I have been informed that 2,000 deaths per year are attributable to obesity in one form or another, which is a huge issue. Perhaps the same type of psychology used to help people to give up smoking could be used to assist people in overcoming obesity, a problem that has played mental havoc with so many people I have known down through the years. The Minister of State and I met yesterday with people in regard to an interesting experiment in education. This programme is currently operated in England by primary and secondary school teachers. This new formula will not add to the curriculum but is integrated with mathematics. I do not have the time now to show how a teacher could integrate this formula with maths or science. However, it is possible to do so.

Photo of Séamus KirkSéamus Kirk (Louth, Ceann Comhairle)
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The Deputy's time has expired.

Photo of Paul Connaughton  SnrPaul Connaughton Snr (Galway East, Fine Gael)
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I hope this experiment will be taken up by Irish secondary schools at transition year level. I hope also it will be rolled out by some Department during the next couple of months.

Photo of Séamus KirkSéamus Kirk (Louth, Ceann Comhairle)
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Will the Minister of State be able to reply in about 30 seconds?

Photo of Áine BradyÁine Brady (Kildare North, Fianna Fail)
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I am afraid it will be a slimmed-down reply. I thank the Deputies for their contributions which were most encouraging because of their sincere interest in tackling this problem. Will the Ceann Comhairle allow me to continue?

Photo of Séamus KirkSéamus Kirk (Louth, Ceann Comhairle)
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I will give the Minister of State some latitude.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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Allow some discretion.

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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The Ceann Comhairle is keeping rural Deputies here. We would prefer to be in our constituencies.

Photo of Áine BradyÁine Brady (Kildare North, Fianna Fail)
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I am sorry about that. I will respond to some of the comments. According to the task force, approximately two thirds of the recommendations have been implemented. A sub-group of the intersectoral group on obesity is working to develop a treatment algorithm for adults and children. The new cardiovascular policy which will be submitted to Cabinet after the Easter break will address the health promotion and prevention aspects of cardiovascular disease, including stroke. It will set population targets for healthy body weight and other lifestyle risk factors.

Mandatory food labelling will be introduced and will allow for the use of national systems, including traffic lights, and guideline daily amounts.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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When?

Photo of Áine BradyÁine Brady (Kildare North, Fianna Fail)
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It is being introduced very shortly. The food pyramid and healthy eating guidelines are being revised and the issue of the portion size, which was raised by Deputy Ó Caoláin, will be addressed in these and in the national nutrition policy. Deputy Sullivan referred to the national breastfeeding strategy operated by the HSE, which is working to give children the best possible start in life through its promotion of breastfeeding.

On capturing the public imagination in the fight against obesity, the little steps all-island campaign for making small but significant changes is in place, and research conducted for it by safefood indicates parents are increasingly aware of the dangers of sugary drinks and snacks and are now reducing the amount of these which they give to their children. SLÁN found no significant difference in participation among different socio-economic groups. The lack of facilities was not seen as a factor, but lack of time was. The most popular form of physical activity in the European Union was walking, which costs nothing. Trying to weigh schoolchildren in the manner suggested was piloted in the United Kingdom and ran into huge problems.

I commend "Operation Transformation" and the catering staff for the way they bought into it by providing healthier options for all of us. Healthy heart at work catering programmes encourage employers to provide healthy eating options in workplace canteens and is run by the Irish Heart Foundation.

On Deputy Connick's point regarding green flags, the Department of Transport ran walk to school Wednesdays as part of the campaign and has the smarter travel programme, which promotes walking and cycling as key modes of active travel. I thank Deputies for their contributions.

Photo of Séamus KirkSéamus Kirk (Louth, Ceann Comhairle)
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I thank the Members of the House for their indulgence in the matter.