Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

I thank the House for inviting me to speak to it about obesity and the measures being adopted by my Department to prevent its spread and reduce the size of this problem.

Before I start, I will to put the issue of obesity in context. As the House will be aware, the Minister of State, Deputy Kathleen Lynch, and I set out 25 actions for this year which are organised under five themes: Healthy Ireland; patient outcomes and safety; universal health care; reform; and the modernisation of the infrastructural facilities. We placed Healthy Ireland as first of the five themes for a particular reason. We believe there is no prospect we will ever come to terms with, or be able to manage, rising health costs and budgets if we do not improve the public health. Similarly, we do not believe we will ever really be able to get on top of the various problems we face in health unless we become healthier, both as individuals and as a society.

This includes a number of actions. The first action is the Healthy Ireland survey, which is now under way. That is the first survey of the nation's health since SLÁN in 2007. The intention is to repeat the Healthy Ireland survey every year so that we can assess whether our public health policies are making a difference.

Members will be aware of the actions taken on tobacco in recent years. The prevalence of smoking in Ireland has reduced from 40% to under 20%. Our aim is to bring it to 5% by 2025. They also will be aware that ten years ago, we were the first country to introduce a workplace smoking ban and one of the first to prevent tobacco from being on display in stores and we will be the second to bring in plain packaging of tobacco next year. We also have action on alcohol. The public health Bill on alcohol will be published before the summer recess and with the Seanad's co-operation, I would hope to get it through the Dáil and Seanad before the end of the year. We have also brought in regulation of sunbeds, which is working well, and quite a number of other public health measures, all of which are enveloped in the Healthy Ireland strategy.

I have come from an announcement this morning with Medtronic, a large firm which has committed €1 million over the next three years to Healthy Ireland-oriented products, and only last week I launched, with the HSE and Philip Lee Solicitors, an expansion of Parkrun across the country. It is good to see the corporate sector getting involved and putting up its own money to support Healthy Ireland because the corporate sector knows it makes sense, both economically and societally, to support public health.

Overweight and obesity are a major serious personal issue in Ireland. Health information from Growing Up in Ireland in 2012, childhood obesity surveillance initiative, COSI, in 2012, the Healthy Ireland survey and many other sources confirm that two out of every three adults and one in every four Irish children are either overweight or obese. It is of great concern to me that Growing Up in Ireland states that one in four three year olds is also overweight or obese. Obesity affects all sections of society in Ireland and there is no other disease or medical condition that affects so many. Furthermore, overweight and obesity are rising. It is estimated that overweight-obesity levels have doubled over the past 20 years and according to the most recent projections from the World Health Organization, WHO, the situation is likely to get worse.

Overweight and obesity are not only about the shape and size of one's waistline. This is not only a cosmetic issue but a real medical and clinical issue too. The World Health Organization recognises this in its International Classification of Diseases, ICD-10.

Overweight and obesity cause, or are associated with, numerous health issues and problems. They cause and worsen the outcomes of chronic diseases, including heart disease, cancer, type 2 diabetes and dementia. Overweight and obesity contribute to 30% of heart diseases and cancers. Being overweight and obesity are also associated with 80% of type 2 diabetes and it makes pregnancy much more complex and a higher risk. According to the evidence, they also affects all of the systems in one's body and most of one's body organs, whether it is endocrine, the circulatory system or organs such as liver, brain or pancreas.

In addition, overweight and obesity are a major economic burden on society. In 2013, safefood estimated the cost of obesity to the Irish health services to be in the region of €1.13 billion. As well as this financial cost, there is also the significant personal and societal cost.People's self-esteem is generally lower, children may be bullied and their mental health is affected. People with chronic diseases are likely to retire early, have poorer health or die early. There is also a significant loss of productivity to the economy and industry.

In 2005, my Department published the obesity task force report. It made 93 recommendations and actions. Although many of these recommendations were implemented, many were not addressed. The most important thing about the report and its recommendations is the fact that it created a strong base on which to build and strengthen any future governance arrangements, structures and programmes. I recognise all of those who were involved.

When this Government came to office, my Department established a special action group on obesity, SAGO. The aim was to advise the Minister, Deputy James Reilly, and now me, on the best available evidence, how best to halt the increase in rates of obesity and how to reduce the burden on individuals, communities and the State. Its work programme includes the development of a new obesity policy and action plan for 2015-2025, publication of revised healthy eating guidelines and a revised food pyramid, the production of a report on top-shelf food which deals with how to reduce consumption of food that is of little or no nutritional value to the consumer, the commissioning of a health impact assessment in relation to fiscal measures, such as a tax on sugar-sweetened drinks, the initiation of a national physical activity plan for Ireland, which will soon be launched, a multimedia campaign to tackle childhood obesity, and the development of an EU joint action on childhood obesity which was initiated during the Irish Presidency of the Council of the European Union.

Additional funding has been made available in 2015 to cater for an increased number of bariatric surgeries at Loughlinstown hospital, in addition to those carried out in Galway. My Department has agreed a new contract with the IMO which will require GPs to weigh children at ages two and five years. This is an important measure, as obesity in childhood has a higher risk of tracking into adulthood.

In addition, industry is making some changes in relation to reformulating certain products, adjusting the size or portion of others and introducing new healthier options. These range from reduced portion sizes to reduced sugar content in some soft drinks, such as Sprite and Coco Cola Lite.

My Department is currently developing the heads of a healthy Ireland Bill which will include provision for calorie posting on menus. It has also assisted in food labelling, the development of a number of treatment algorithms and clinical guidelines, providing for child monitoring in primary care, and developing with the Broadcasting Authority of Ireland a code of practice on advertising of food to children. We are also working on a code of practice for the food industry on advertising, product placement and sponsorship. The Department of Health, the Department of Transport, Tourism and Sport and a number of other key stakeholders are currently developing a national physical activity plan to encourage greater levels of physical activity by everyone living in Ireland. This is the first time that concerted action will be taken by a range of different stakeholders to get more people in Ireland active. It is expected that the plan will be presented to Government and launched later this year.

Although my Department has put in place many measures to address the major public health issue that obesity presents, it is important to point out that we have not as yet managed to reverse the trend. In fact, the European Office of the World Health Organization states that if obesity is not addressed, all of its member states will see massive increases in obesity. According to these predictions, Ireland will be top of that league. It is important to understand that the authors of the World Health Organization report have stated clearly that the method of collecting data is different in every country and, therefore, one has to be cautious in its interpretation and especially in comparing one country with another. The Irish data used in WHO predictions is based on actual measurements, whereas other countries base theirs on reported data. This is a very important distinction because most people, and a large number of clinical professionals, underestimate weight when they do not actually measure it. Secondly, the Irish data used is more than seven years old and does not take into account the successful efforts that have been made in Ireland during the period since then. Third, we have more recent data about childhood obesity which they did not use, which gives us some grounds for optimism.

We all know that excess weight and obesity develop over a long time. Everyone is at risk of developing obesity at any stage of his or her life. By reducing childhood obesity we expect that adulthood obesity will be reduced too. The childhood obesity surveillance initiative carried out by the National Nutrition Surveillance Centre in UCD in 2012 showed a reduction in the proportion of obese children at age seven, from 6.2% in 2008 to 3.8% in 2012, and stabilisation of the proportion at age nine, which remained at around 5%. The results of the Growing Up in Ireland survey carried out in 2012 found that one in four children as young as three years of age are overweight or obese. The same group followed up at the age of five showed that the figure has decreased to one in five. This means that we need to be cautious about the forecast estimates in the WHO report, which are easily misunderstood and even more easily sensationalised by the ill-informed or those who are uninterested in the facts.

Obesity is not as simple as many people think. The risk factors are multiple and complex and there are many inter-relations. At its simplest form, obesity is caused by an excess of energy intake over energy expenditure. The Foresight Group in the UK attempted to map out all the various causes, risk factors and interactions and came up with over 90 different issues to be addressed. They grouped these into different domains: medical, biological, technology development, infrastructure, food, activity, economic, social, and media and communication. In short, these domains represent a complex picture of interaction and when any of these is unbalanced it can lead to overweight, obesity or, indeed, underweight and malnourishment.

McKinsey Global Institute looked at the issues and concluded that, first, it was high time to act, second, that we must all act together, and third, that there is no one solution or game-changing action. However, McKinsey looked at 74 interventions across 18 groups and agreed that the most effective interventions can be grouped into 17 actions. These include calorie or nutrition labelling, parental education, portion size control, weight management programmes, increased physical activity, health promotion campaigns, food reformulation, bariatric services, workplace wellness, and fiscal policies that combine taxes and subsidies. In its analysis, it had taxes and subsidies listed towards the bottom, and issues such as weight management programmes, food reformulation, portion size control and bariatric surgery towards the top. It emphasised that, based on existing evidence, any single intervention is likely to have only a small overall impact on its own, and that high-profile public information campaigns on their own are not effective.

McKinsey also acknowledged that a systematic sustained portfolio of initiatives, delivered at scale, is needed to address the health burden of obesity. As I said earlier, we are developing a national obesity policy and action plan. There will be a requirement for all sectors and communities to work together, as there will be little benefit if one sector succeeds while others do not. Government, local government, the food industry, sports and recreation, communities, media, voluntary organisations and so on all need to work together. It is imperative that we do. The obesity policy will be ambitious in its scope and will cover the whole spectrum from prevention and early intervention to treatment and care. It will set clear targets and a clear set of responsibilities for achieving these targets. The policy will take a lifespan-based view, including maternity and childhood phases. The action plan will be concise, with a limited number of actions and a focus on outcomes. I expect a suite of measures will be required in the areas of legislation, regulation, the health service, education, physical activity, sport, transport and planning.

My Department and I have initiated a consultation process on the new national obesity policy and action plan. In April 2015 a very productive consultation day was held in Farmleigh with 112 key stakeholders present. One of the presentations on the day was delivered by Sorcha McKenna of the McKinsey Institute. A report on the national consultation day is being prepared and will be published shortly. Last month the Royal College of Physicians in Ireland, RCPI, consulted with health professionals and health providers, and in September 2015 a final consultation day will be held to obtain the views of children and young people. The views and input from each of these important consultation exercises will ultimately result in a robust and comprehensive obesity policy and action plan with buy-in.

Ireland has a good history of successfully managing high-risk public health issues through collaboration, whether it is fighting infectious diseases such as cholera, polio or TB in the past or dealing with the risk posed by smoking and, more recently, road traffic collisions. We have shown in the past that these things can be done. In the future, we need to treat alcohol misuse and overweight and obesity with the same degree of importance.