Catherine Noone (Fine Gael) | Oireachtas source

I welcome the Minister to the House and welcome the debate. I speak about this issue practically every week. I feel very passionate about it, not least because I suffered from obesity as a pre-teenager and teenager. For personal reasons, I come to the subject with a lot of knowledge. A recent report compiled by the World Health Organization predicted that Ireland was on course to be the fattest nation in Europe by 2030. While this seems quite far away, in terms of what we might implement in policy terms, it is not far away at all. I note from the Minister's speech that many things are happening, and one line of his speech which resonated was: "Obesity is not as simple as many people think." I would see this from a treatment point of view but also from the point of view of how a person arrives at the point of being obese, which is very complicated. As Senator Byrne said, our perception of overweight and obesity has totally altered. We might think: "Ah, she's grand. Sure doesn't she fit into a size 14 or 16. She's not overweight. She's lovely. Hasn't she a pretty face?" It is about health. We have a skewed reality and people do not see others as being big when they are big, and that is the reality, although "big" might be the wrong word and "overweight" or "obese" might be preferable.

As a woman, I have chosen to pick one topic because I know there is such a cross-over in this area. I recently did some work in regard to the time before conception, breastfeeding and everything in and around women's health when it comes to babies. The fact remains that once obesity has developed, treatment can often be unsuccessful. As such, I believe early prevention efforts are urgently required. When I say "early", while people speak about zero to six, I believe that even the time before birth is highly important. Undoubtedly, the seeds of the current obesity crisis facing our adult population were planted in childhood or even earlier.

To date, the World Health Organization, Obesity Canada, the US Institute of Medicine and the UK Government have all acknowledged maternal obesity and pregnancy as primary targets for prevention of downstream childhood obesity. A recent study conducted by the Best Start Resource Centre in Canada has identified maternal obesity as a strong risk factor for impaired downstream physiological health in offspring. According to the report, the odds of offspring being overweight at age seven years have been shown to increase by 3% for every 1 kg over the recommended weight gain guidelines of the expectant mother. These children are at increased risk of metabolic disorders later in life, with increased offspring size being a key indicator in this relationship. The study went on to reveal that, for the expectant women themselves, there is compelling evidence that those who are obese during their childbearing years are at high risk of developing type 2 diabetes, hypertension, respiratory issues, cardiovascular disease and depression, and indeed, difficulties in conceiving in the first place, which are all a huge cost to our health service. Moreover, the risk of any form of obstetrical complication is three times more likely in mothers who are obese as compared to mothers who are not obese. As BMI goes up, so does the risk of negative prenatal outcomes for the mother and-or the baby.

The most notable complications obesity can cause in early pregnancy include increased risk of spontaneous abortion and recurrent miscarriages. Here in Ireland, a research paper on trends in maternal obesity from 2009 to 2013 revealed that one in six women presenting for antenatal care is obese, one in 50 is morbidly obese and the number of severe obesity cases increased by 48.5% over that time, which is massive, if the House will pardon the pun. These statistics were taken from a study of over 40,000 women who attended the Coombe from 2009 to 2013.

What can be done to tackle this worrying trend? Obesity is considered a modifiable risk factor. During pregnancy, women are far more motivated to adopt healthy behaviours, believing their child may benefit, as evidenced by reduced alcohol consumption and smoking in most cases, although, unfortunately, there are exceptions to that. Past efforts to advise women on healthy weights for pregnancy have focused less on maternal obesity and more on the concerns about low birth weight delivery outcomes. Certain measures, I believe, could be implemented to curb the growing trend of maternal obesity in Ireland. These would include educating women of child-bearing age through the media and health care providers about the impact of their health and weight on their own well-being and on the health and well-being of their children. No matter how difficult it seems to put that across in the media, or how difficult it is for men to hear about these women's issues, it is something that should be done. We should also adopt a standardised prenatal education curriculum and ensure courses are accessible and affordable for all women. The prenatal period is a crucial time of growth, development and physiological change in mother and child. It provides a window of opportunity for intervention via maternal nutrition and physical activity that can benefit the mother and baby.

I would also like to touch on the subject of breastfeeding and obesity reduction. The health benefits of breastfeeding are widely acknowledged, although I will not go into that as it is pretty much accepted. Breastfeeding has long been recommended for the health of the mother and the baby. While I do not know the full statistics, we perform very badly at an international level when it comes to this and something clearly has to be done about it. If a child is breast-fed, they will perform much better from a health point of view throughout their life, not just in terms of obesity. A systematic review in Canada indicated that women who are overweight or obese are less likely to initiate breastfeeding or tend to breastfeed for a shorter period of time. There are a number of potential factors, including biological, psychological, behavioural and cultural factors. Exclusive breastfeeding for six months has been shown to reduce maternal gastrointestinal infection, helping the mother lose weight.

In conclusion, a healthy, active pregnancy may well contribute to minimising the intergenerational cycle of obesity. As such, we must now ensure the measures we adopt to tackle obesity also include work in this area. The Minister referred to the weighing of children at two and five years of age. I think this a very good idea but, as Senator van Turnout asked, what exactly will that entail? I believe we should be quite scientific about this. I know this is controversial but it is an opportunity for parents to interact with the idea of their child having a problem and to address it. The Minister in his speech also referred to the Foresight Group in the UK, which came up with over 90 different issues to be addressed. The Minister read out a list of issues but I believe psychological issues are huge in all of this. I agree with much of what other speakers have said. I could go on all day, but I will conclude. I again thank the Minister.