Seanad debates

Wednesday, 17 June 2015

Tackling Obesity in Ireland: Statements

 

10:30 am

Photo of Diarmuid WilsonDiarmuid Wilson (Fianna Fail)
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I welcome the Minister, Deputy Varadkar, to the House.

Photo of Leo VaradkarLeo Varadkar (Minister, Department of Transport, Tourism and Sport; Dublin West, Fine Gael)
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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.

Photo of Thomas ByrneThomas Byrne (Fianna Fail)
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I thank the Minister. This is a crucial issue for society. The Minister may think he is presenting some good news on it but the facts show that this a problem that is getting out of control. I am not sure how seriously he is taking it. I have lost about two and half stone since I came into the Seanad. It is a difficult process. There are certain simple things that could be adopted to help people along the way, because it is very difficult if one is eating too much and not exercising enough. That is the bottom line. First and foremost, diet drinks need to be looked at. Somebody who slugs a diet drink all day is usually very fat or obese. More and more research about the sweetener aspartame indicates that it does not help people on diets but encourages them to eat sugary products as well as drink diet drinks, thereby causing obesity. One does not see slim people slugging diet drinks but overweight people slugging them. There is anecdotal evidence which is backed up by research, if the Minister wishes to look at it.

Diet drinks need to be regulated and Fianna Fáil has proposed a sugar tax on sugary drinks. The issue of sugar is crucial and we are lucky in this country that we do not have the high fructose corn sugar they use in America, which is directly related to the massive obesity epidemic there. When it first came onto the market in the 1970s in America, obesity shot up but we are very lucky we do not have it in this country because of EU quotas. If we had it, we would have a much bigger problem.

Another issue is whole foods. In my experience, one can eat as much wholegrain rice and wholewheat bread as one likes as one will get full very quickly. However, if one eats white rice or white bread, one does not get full. This is an educational issue which needs to be addressed. There is also an issue with consumer product labelling as it is absolutely impossible to know what type of bread one is buying in this country. One has to check the label because wholegrain bread is simply white bread with a few grains in it. If it is wholewheat, it is possibly good and has a higher fibre and higher protein content, which makes one fuller. We have to get this information to the consumer because when consumers buy brown bread, which they think is healthy, most of the time they are buying coloured white bread and such products are contributing to the obesity epidemic. We should encourage people to eat wholegrain rice because it is impossible to eat a lot of it. It is full of the nutrients which are taken out when it is processed. These suggestions might sound completely radical but they are based on my experience. It is not possible to eat too much of those foods whereas it is easy to eat too many sugary foods and processed carbohydrates. We should encourage people to eat whole products, such as rice, pasta and bread, which are labelled as to whether they are brown pasta or wholewheat pasta or brown coloured bread or wholewheat bread. They are the simple tips I would give to people. lf they can stop drinking diet and sugary drinks, they should do so as they are not good for them. We should drink water or cups of tea.

The Minister mentioned some of relevant issues, such as active travel, cycle lanes and safe walking options, which need to be put in place. My kids cannot walk to school due to bad planning by Meath County Council over many years. As I said before, I am grateful that I do not have that on my conscience as many people do. The state of planning in many parts of this country is terrible but I have never been a member of that council. If my children could walk to school, they would do so, even though it is probably a mile and a half. They would cycle, and I will see if the six year old will cycle next week because he is just learning to cycle. In the absence of cycle lanes, however, it will be dangerous. It would be far preferable, as they get older, if they could cycle or walk to school.

Poverty is a huge issue as well. People go for what they perceive to be the cheapest and most convenient foods but they are often dangerously full of sugar and processed carbohydrates. We talk about putting resources into addressing this problem but if we gave consumers information, it would help because the good products can be much cheaper. Water is a lot cheaper than diet drinks, no matter what charges the Government proposes putting on them. Poverty is a problem all over the world and we need to educate people as to how to cook food. Some people think they cannot cook but they certainly can if they are shown how to.

I am sure I was clinically obese a few years ago. I was not like the typical image of an American with the belly hanging out. People are in denial about this because they can get clothes in the shops that fit them, but we must not be in denial. I still have a bit to go and it will be hard. We must stop telling people they look great when they do not. It is very important for children to have free play and physical activities at school and at home. Children have no business watching television during the summer if there is good weather. It is a matter for parents but my children have no business watching television during the day. It can be hard at times but I send them out the door, into the garden or to cycle around.

One of my children was diagnosed recently as being grossly underweight, requiring a procedure in a hospital. However, we were told there was a waiting list of five months. It was suggested to my wife that she ring her local Deputy as that might result in getting it done more quickly. The Minister has been campaigning against that issue but I think that is a smokescreen for the fact the waiting lists are so long. He has been saying it is terrible what politicians do but I will certainly make representations any time I can. We are still waiting and it is a disgrace.

In another example, where I am glad I made an intervention, a child with suspected cancer and a family history of melanoma was told no dermatologist was available in Temple Street Children's University Hospital. The family was told to check with the GP if they had further concerns as the hospital could not give them an appointment. I wrote to the chief executive saying, "Surely there was some mistake". An appointment was given three days later. Thank God that parent came to me and I wrote that letter. It is fortunate the parent was not put off by the Minister's comments about politicians getting appointments because there had been a major error.

I have referred to two examples where the waiting lists have not been addressed but nowhere is it more evident than in respect of obesity clinics and bariatric surgery. A lady contacted me recently who was very upset at the waiting time she had to endure, although I can see on Facebook that she is making huge efforts herself. She needs assistance but there have been huge cuts and the surgeon concerned has been on the radio on a number of occasions.

We have to look at all the up-to-date evidence in regard to obesity and take what the food and drinks industry say with a grain of salt, if Members will forgive the pun. We have to look at all the latest research on artificial sweeteners, sugars and processed foods and try to impress on people that they can cook good food more cheaply than buying processed foods. I urge the Minister to look at the labelling of bread as it is not possible to know what one is buying. One can eat more healthily by picking certain products over others.

Photo of Colm BurkeColm Burke (Fine Gael)
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We are facing major problems in this country and I agree with what the Minister had to say about the World Health Organization. We have a growing problem and, while we seem to have been able to get to grips with the health problems caused by smoking, obesity is now our most serious problem. It has moved ahead of smoking as an issue. Some 61% of Irish adults are overweight or obese and one in five primary school children and teenagers is overweight or obese. The current policy and an action plan are under consideration, to be finalised by the end of 2015. The policy contains three elements, namely, prevention, treatment and research, all of which are very important elements of the policy.I understand that safefood Ireland, which is in the process of doing further research in this whole area, has invited tenders to determine the direct health care costs per capitaof an obese child. It may well have appointed someone to carry out that research at this stage. Part of the research involves determining the lifetime indirect costs, such as the cost of the loss of earnings attributable to premature mortality, disability or illness, and assessing the financial benefits of prevention and early intervention in childhood. This research is being done at present.

Many health and psychological problems in young people are attached to childhood obesity. The health problems include respiratory disorders, high blood pressure, sleep difficulties and musculoskeletal disorders. The risk of type 1 or type 2 diabetes is a growing problem as well. In this context, I was interested to read an English report about changes that occurred there between 2000 and 2012. Those who compiled the report worked out that there had been an increase in the rate of hospital admissions among people with an obesity diagnosis between the ages of five and 19 who had health issues. In 2000, there were 93 admissions per 1 million of population. By 2012, this had increased to 414 admissions per 1 million of population. If the same figure applies here in Ireland, we are talking about over 2,000 admissions per annum into hospitals as a direct result of overweight or obesity. I think that shows the seriousness of it in terms of cost and demonstrates why it is extremely important that we tackle this problem.

There are no easy solutions. Some people have suggested that we tax sugar, but we already impose a tax rate of 21% on items like sweets, chocolates, confectionery, ice cream, crisps and soft drinks. Should we increase that tax? There is a discussion on that at the moment. One change will not bring about the necessary solution to this problem. It is interesting that the authorities in Denmark have introduced a tax on all foods with more than - I think - 2.3% saturated fat, including pizza, butter, cheese and oil. Given that this tax equates to €2.15 per kilogram of saturation, it works out at approximately 20 cent on a pound of butter. Hungary has also imposed taxes on certain food items that have high levels of salt and sugar. I am not sure that is the solution.

As the Minister has pointed out, there is no single simple solution to this problem. A range of things need to be done over a period of time. For example, we need to focus on the whole area of education, for example by outlining the difficulties that can arise when people are overweight or obese. I was interested to read in a 2011 study conducted by Professor Tim O'Brien in NUI Galway that 54% of parents of overweight children and 20% of parents of obese children reported that their children were approximately the correct weight for their height. If such a high percentage of the parents of children who are obese or overweight feel their children do not have a problem, it is clear that there is a lack of knowledge in this area. The study in question also identified that three quarters of children in Northern Ireland and four fifths of children in the Republic did not meet Government physical activity guidelines. That was back in 2011. I know we have moved on and made some progress since then, but we have a lot of progress to make.

I would like to mention some simple things that could apply in schools. I recall arguing with one of my colleagues about the need for a school to get a hall built. It had been on the agenda for over 18 years. I had been told the project was not included in the building programme of the Department of Education and Skills. More than 400 children were attending the primary school in question, but it had no internal facility for physical activity. The children could not go out if it was wet or the weather conditions were not suitable. In fairness to the Department, it subsequently decided to allocate the funding. The project is now almost complete and I welcome that.

When we are planning housing, we need to make sure we provide adequate facilities for young people to exercise in. When I reflect on the way we have planned housing over the last number of years, I would not necessarily say we were right to impose heavy charges with the intention that local authorities would develop services, many of which subsequently were not necessarily developed on time. I was interested to speak recently to somebody working in Edinburgh who told me about a case in which a builder who purchased over 200 army houses for refurbishment had to assess the facilities required by the young families that were going to live in those houses. The builder was required to extend the local school and provide the playgrounds and other facilities needed by young people at the same time that he was working on the houses. That is the way we need to look at it. We need to consider a number of major issues, the most important of which is education. We also need to make sure we have facilities available for people. It goes right across a number of Departments. There has to be a co-ordinated approach.

I welcome the Minister's decision to have the review completed by the end of the year. It is important, given that we have set out plans before. If one examines what was actually implemented on foot of the 2005 report, I am not sure one will find that huge progress was made in implementation. It is great to produce documents and policies about what we should do, but we should also set target dates for constant review six months, 12 months or two years down the line. That is the only way to ensure the policy decisions that are taken are implemented. I welcome the submission the Minister has made to the House today and his commitment to this issue. It is important that we make progress with how we are dealing with it. We need to try to work towards bringing about solutions.

Photo of Jillian van TurnhoutJillian van Turnhout (Independent)
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The Minister is always very welcome to the House. The time he has dedicated to today's debate shows that he has an understanding of the importance of this issue and the serious health concerns associated with it. There is no doubt that we are IN the midst of a full-blown obesity epidemic. It is shocking that 61% of adults and 22% of children between the ages of five and 12 are overweight or obese. Given that this issue is so costly and damaging to the health and well-being of the nation, it is difficult to understand why we are still discussing strategies rather than implementing the excellent strategies we already have. The national task force on obesity has been operating for almost ten years, but its recommendations have been implemented in a partial and haphazard manner. The then Minister for Health, Deputy Reilly, established a special action group on obesity in 2011. This group highlighted priority areas and policy recommendations, such as an introduction of a sugar tax and the improvement of nutritional labelling. These are very cost-effective ideas, but four years on there has been no action towards implementing any of them. Children remain particularly vulnerable. The Government's failure to act is having a particular impact on them. They are increasingly vulnerable to chronic diseases, premature deaths and disability in adulthood.

Given the negative impact of obesity on people's health, it is understandable that we talk about it in a critical and negative way. However, we need to be mindful in our discourse that obesity and excessive weight are realities that people live with and struggle to overcome. This is especially important when we talk about childhood and adolescent obesity, which can have a significant impact on the self-image, self-esteem and confidence of the young person affected. For many years we have associated malnutrition with lack of food or starvation, but in fact that is under-nutrition. Obesity is the result of malnutrition, which is a poor diet with a lack of adequate nutrition for proper growth and development.Not everyone who is malnourished is overweight or obese but this does not mean that he or she is not seriously damaging his or her future health. It is imperative, therefore, that we shift the focus to a more holistic healthy lifestyle approach, with nutrition and exercise as its linchpins. We must tackle the unhealthy obsession that has developed about being fat, counting calories, "yo-yo" dieting and losing weight, all of which are serious issues among young adults, especially females.

As previous speakers pointed out, school is where children spend the majority of their time in the company of their peers. Physical education in schools is essential to a child's physical and mental development. The children's sport participation and physical activity study of Irish students in primary and post-primary education found that a mere 35% of primary pupils and 10% of post-primary pupils received the minimum 120 minutes of physical activity in school per week, as recommended by the national task force on obesity. One in four of the children surveyed was unfit, overweight, obese or had elevated blood pressure.

A 2013 report by the European Commission, Physical Education and Sports at School in Europe, found that the provision of physical education at primary level in Ireland is the third worst in the European Union, while at post-primary level, it was found to be seventh worst in the EU. This failure to ensure the weekly minimum of 120 minutes of physical activity for children is a serious blow to children's health. We must promote physical activity, participation in physical education and non-structured play during school hours. Children should be encouraged to engage in team sports, join activity clubs in the community and simply enjoy the outdoors. When they learn these habits at primary school level they continue to be active throughout their teenage years, thus reducing the risk of obesity.

I am concerned that parents do not have control over children's eating habits when they are outside the home. While healthy lunch policies are widely implemented in primary schools, they tend to be abandoned when children enter secondary school. Research carried out this year by the Irish Heart Foundation on food provision in post-primary schools found that 51% of students have daily exposure to foods that are high in sugar, fat and salt and that these are widely available not only outside the school gates but also in school tuck shops and vending machines. There is no statutory requirement on schools to provide meals and hot food to students throughout the school day, although many schools have canteen facilities. Given the obesity epidemic we face, it is alarming that no national guidelines or standards are in place on the types of food and drinks available for children to buy. With no time for exercise and sugary, fatty foods surrounding children everywhere, it is little wonder that childhood obesity rates are high. If we continue to ignore this issue, our children's health will only worsen.

Obesity is also becoming a problem of poverty. Convenient cheap foods that are high in calorific value and low in nutritional value are becoming the norm for lower income families. Why are convenient healthy foods the most expensive option? Anyone who visits a canteen or shop will see that convenient healthy foods are the most expensive option. The cost of healthy food is becoming a barrier to a healthy diet for families. For this reason, I support the introduction of a sugar tax. The money generated from such a tax should be used to fund projects such as family food initiatives. These are projects that help to improve the availability, affordability and accessibility of healthy food for low income groups at local level using a community development approach. The objective is to help families to achieve a healthier lifestyle.

The Minister raised the issue of free general practitioner care for children aged under six years and the two health checks available for this age cohort. While these are excellent initiatives, one of the issues people have raised with me is that they do not provide access to a dietitian or nutritionist in cases where a general practitioner encounters a problem. The schemes present an opportunity for general practitioners to engage with parents and provide them with nutritional information. As the Minister is aware, I fully support free GP care for children aged under six years.

An issue arises regarding choice architecture. The Department organised a seminar some weeks ago on what is known as the nudge policy and a number of simple steps that could be taken in this area. One need only visit a local shop, supermarket or canteen to observe how choice architecture is being used. It is easy for shoppers to grab the unhealthy option. While many of us agreed with Senator Byrne's interesting comments on food, these issues do not always click for us. If Members are not getting this information easily, how much more difficult must it be for someone managing a family and in a rush to do so?

I thank the Minister for his attendance. My message is that we have policy blueprints and it is now time for action.

Photo of Diarmuid WilsonDiarmuid Wilson (Fianna Fail)
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Before calling Senator Hayden, I welcome Deputy Jim Daly and his guests to the Visitors Gallery.

Photo of Aideen HaydenAideen Hayden (Labour)
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I welcome the Minister to the House to debate this important issue. I will refer again to some of the statistics previous speakers cited. Almost one quarter of Irish adults are obese and a further 37% are overweight. According to the Irish longitudinal study on ageing led by Trinity College Dublin, to which the Minister referred, four out of five people aged over 50 years are overweight or obese. According to the Irish Heart Foundation, one in ten children aged between five and 12 years is overweight and a further one in ten of this age cohort is obese. In total, 22% of children aged between five and 12 years are overweight or obese. In just one year, Ireland's only dedicated childhood obesity treatment programme, which is located at Temple Street Children's Hospital in Dublin, experienced a 400% increase in referrals of children under five years.

The annual cost of obesity has been mentioned but is worth repeating. Of the estimated cost of €1.13 billion, 35% or almost €400 million is attributed to direct health care costs, with the remaining €728 million made up of indirect costs such as reduced productivity and absenteeism.

The Minister referred to a research project undertaken by the World Health Organization. A study carried out by safefood Ireland, which was carried out in 2012 and is, therefore, somewhat out of date, found that the main drivers of direct costs are drugs, hospital inpatient and day case care, cardiovascular disease, type 2 diabetes, colon cancer, stroke and gallbladder disease. People would very much like to avoid all of these diseases.

The overwhelming influences on obesity - in 99% of the obese population - are environmental and include marketing, advertising, increased portion sizes, accessibility and availability of foods and food facilities and increased automation and car use, among other factors. Long-term weight loss is extremely difficult to achieve. Having visited Weight Watchers on a couple of occasions, I found it slightly depressing to discover that adults who remain in conventional weight loss programmes can realistically expect a maximum weight loss of only 10%. According to the World Health Organization, nearly all Irish adults are likely to be overweight 15 years from now.

On the key causes of obesity, one article in a recent series in the medical journal, The Lancet, identified a clear primary culprit, namely, a powerful global food industry which is producing more processed, affordable and effectively marketed food than ever before.

I fully concur with Senator van Turnhout that one does not have to visit many supermarkets to recognise the difficulties experienced by people on low incomes given the ease with which one can fill a shopping trolley with cheap, pre-produced pizzas and other types of unhealthy foods that are loaded with sugar. Critics have concluded that the problem lies with the food industry, particularly the growth of processed foods, recipes that are high in sugar, salt and fat, and large portion sizes, poor nutritional labelling and aggressive marketing of unhealthy food, especially to children.

Scientific findings indicate that the "eat less, move more" approach is not necessarily a common sense solution to the obesity problem. Despite the rise in gym membership and an increasing focus on exercise, weight problems continue to climb. It appears that while exercise is important to maintaining one's health, it is not necessarily a weight loss solution. According to Margo Wootan, the director of nutrition policy at the Centre for Science in the Public Interest, "We are not going to exercise our way out of this obesity problem." Weight is not a matter of calories in and calories out. As Senator Byrne pointed out, foods with high levels of protein, fibre and other natural elements take longer to digest and result in lower, longer spikes in blood sugars. On the other hand, processed foods are easier to digest and result in high spikes in blood sugars. The liver is unable to process this sugar effectively and therefore produces insulin which turns it into fat. High levels of insulin can also block the brain from receiving the signal that one is full. I understand this is known as "insulin resistance". Unfortunately, foods with reduced fat and calories tend to have higher levels of sugar and other sweeteners.This is not often understood. People fill their trolleys with low-fat foods, not understanding that, in actual fact, the additional sugars in those foods can be doing them more harm.

Sugar is highly addictive. In a study at the University of Texas, 43 cocaine-addicted rats were given the choice between cocaine and sugar water over a 15-day period, whereby 40 of them chose the sugar. Sugar is, in fact, eight times more addictive than cocaine. Artificial sweeteners increase the appetite as the body expects sugar that is not coming. They add to our sugar problems rather than decreasing them, which brings us back to the argument that we should not be drinking "diet" drinks.

Sugar is also added to foods other than sweets and desserts, such as pasta sauces, salad dressings, cereals, yoghurts, ketchup and fruit juices. Kids today have grown up surrounded by these highly addictive foods. I never saw pizza when I was growing up, and now it is sold in newsagents, supermarkets, petrol stations, chemists and even clothes shops. We see ads on TV and signs as we walk down the street. We have celebrities endorsing soft drinks and cartoon characters on cereal boxes. Many unhealthy foods are targeted directly at children and sold in lunch-box sized portions.

We need to regulate how we market food to our children and should not be encouraging children to develop unhealthy habits and buying patterns that follow them into their adult years. To successfully address obesity, people must consume fewer calories, which means eating less food or, at least, different types of food. This implies less industry profit. The most processed foods with the highest profit margins are often made by the biggest industry players with the most skin in the game, so to speak. We need to try to improve the quality of our people's food choices by ensuring that they are informed and have more access to healthy foods. We must also ensure that companies are disincentivised from providing unhealthy foods, for example, by requiring them to pay for any negative eventualities they cause. Fizzy drinks companies should not be welcome in our schools or sports clubs, no more than machines selling cigarettes, beer or vodka would be. They cause addiction and cancer, and they continually manipulate our children through their advertising and their attraction.

Like Senator van Turnhout, I have previously called for a ban on soft drinks machines in schools. I received comments that schools are actually receiving much-needed resources by having these drinks machines. That is something we have to deal with. I have also considered the issue of a sugar tax, which has come up before the finance committee in successive budgets. The one thing that has always put me off the idea is that the people who will end up paying it are those who can least afford to do so - the poorest in Irish society. I favour the imposition of a sugar tax only if it is ring-fenced to deliver healthy school meals in areas where children live in poverty. We have one in ten children going to school hungry.

In conclusion, I welcome the consultation process in which the Minister has engaged, although I hope he is not going to spend too long consulting. There is sufficient evidence internationally and in Ireland to tell us what the problem is. We just need to get around to the solution.

Photo of John CrownJohn Crown (Independent)
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I welcome the Minister and I am sorry I was not in the House for his opening address.

I welcome the priority he and the Government will give to this problem. Many of his medical school classmates, younger women and men than me, will be spending long careers dealing with the consequences if we do not tackle this problem now. There has been an incredible explosion in knowledge about the true nature of the problems caused by obesity, reaching into areas we never would have thought were relevant at the time when I was in medical school. In my own area of expertise, we now recognise obesity as being one of the principal avoidable causes of cancer.

Before Senator Hayden leaves, I must compliment her on the tour de force she gave us on insulin metabolism. I think I am going to record it as I believe I may have qualified for some continuing professional development points in listening to her presentation. It was excellent.

It will be obvious to people who work in the health system that there is a very close correlation between several unhealthy behaviours and social and educational class. There is no doubt about that. The reasons are complex and need to be approached with an open mind. Smoking has become a more common problem in people who have lower educational achievement and economic access. This provides a double level of tragedy for those people - of course, none of us should be smoking in the first place - as the power of the addiction can rob resources where they are most scarce.

Counter-intuitively, there is a definite phenomenon of obesity becoming a problem of poorer people. This has become very obvious in the United States. Senator Hayden mentioned the role of relatively cheap access to processed food, which, although part of the problem, is clearly not its sole cause. I firmly believe that a big part of the problem revolves around education. We will find that people who have a higher level of educational achievement are more likely to be susceptible to messages about important health modifications for themselves and their families. It is important that, when we look at the strategy, we focus on the disproportionate toll which the scourge of obesity will bring to those who can least afford the illnesses.

I would like to take advantage of the Minister's presence in the House to mention that we in the oncology community have all come back recently from the American Society of Clinical Oncology. By common consent, it was the most epoch-making meeting in the history of the society, certainly in the past 20 years. There is a torrent of new data for new treatments, many in the area of immunotherapy. There are very promising data in some types of breast cancer and bowel cancer. However, the drugs are going to be extraordinarily expensive. There will be a colossal battle over the next four to five years about the health-economic implications of some of these new treatments. I would like the Minister to commit to the idea of putting a ring-fenced additional tax of €5 on a packet of cigarettes, which can be used only for the purchase of treatments for smoking-related illnesses, including cancers, cardiovascular diseases and chronic lung disease. It would be groundbreaking for a Minister to ring-fence a specific tax for one purpose, so that the sticky fingers of the Exchequer could not use it for paying off financial burdens incurred by others, bank debts, pension funds or anything else. We would still charge the good old Revenue tax on cigarettes, which would help with our financial obligations and pension funds. This is relevant to today's discussion because several of the illnesses which are consequences of obesity are also consequences of smoking.

On the issue of specific financial disincentives, that is, forms of tax for dietary supplements, etc., I saw today that several jurisdictions in the US are moving towards a complete ban on trans fats. They intend phasing them out completely over the next three years, as other speakers may already have mentioned. That may well be something we should consider here.

I wish the Minister well in his various undertakings. We can still do a little bit of work on the smoking space. I am sorry to cross outside the remit of today's debate but I have the Minister captive here. We are not allowed to propose Bills on taxes in the Seanad so I cannot do it, but I want to put the thought into the Minister's head that he might. I also ask him to look critically at the social and educational factors, which need to be addressed if we are going to tackle the obesity scourge.

Photo of Catherine NooneCatherine Noone (Fine Gael)
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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.

Photo of David CullinaneDavid Cullinane (Sinn Fein)
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I welcome the Minister to the House again. They say that looks are deceiving, and I am not someone who is going who is going to be characterised as being obese any time soon, and that is for sure. I say this in order to pick up on a point made by Senator van Turnhout, who said that we should look at this differently. Obviously, obesity is a big problem and we are going in the wrong direction in that area. However, there are many people who may not present themselves as obese but they are not eating healthily. For example, I drink a lot of coffee, eat far too many sugar products and I like all of the drinks we spoke about earlier, such as Coke and Lucozade, and I eat a lot of crisps and sweets. I simply make the point that there are people who look healthier than they are. Therefore, Senator van Turnout is right that this is about healthy eating and healthy living and not just people who we can see are obese, but also those who may not be eating properly. There is an issue within that which needs to be looked at.

The most recent World Health Organization reports predict that Ireland is heading for a massive increase in rates of obesity and excess weight. This is extremely concerning as, if it were to happen, it would have a severely negative effect on the health of our nation. There are a number of issues. Obviously, there is the impact that obesity has on citizens and the fact that we will have more unhealthy citizens but there is also the cost it will have on the State, given there is a huge cost associated with obesity and unhealthy living and eating. We know the cost of obesity could more than quadruple within the next 15 years, with a potential increase of €1,175 a year for every individual in the State. The annual obesity cost at present is €1.13 billion but this could reach as high as €5.4 billion by 2030 unless action is taken urgently.

Obesity affects disadvantaged sectors of society disproportionately but it is a problem that society at large must face for the good of our own health and so we can avoid the costs to our services that come with it. The Government obviously has a very important role to play in regard to education and raising awareness, and some of those issues were raised by other Senators. The State has to step up to the plate and ensure the type of predictions we are hearing from the World Health Organization and other organisations do not become a reality. None of this is inevitable; it is only inevitable if we do not take the necessary steps to prevent it from happening.The World Health Organization predicts a massive increase in obesity for Irish women, soaring to 57%, while the proportion of obese Irish men is expected to increase to 48%, according to these reports. Healthy Ireland is the 2013 national framework for action to improve the health and well-being of our citizens. While it is a strategy and recognises the challenges facing our health system and focuses on obesity, it does not offer enough solutions. We need to consider a more solution-based approach to this issue. We have seen the heads of a Bill on calorie posting on menus in food outlets and we have been informed by the Minister it will be introduced in 2016. This needs to be made a priority. Sinn Féin wishes to know when the Bill will be enacted and what other measures the Minister will take in light of the predictions we hear from the World Health Organization and others.

The Minister established a special action group on obesity which organised a three-year media campaign that began in 2013. The Minister may have touched on this in his opening speech, but unfortunately I missed part of it. Will the Minister give us an update on the effectiveness of this campaign? What has the State achieved from it?

Last year, we saw the 2012 statistics from the European childhood obesity surveillance initiative, which suggested obesity among Irish children is 20% but the rate is stabilising in some groups. This is not the case among disadvantaged groups. The latest report concludes the prevalence of overweight and obese primary school children aged nine has stabilised, and among seven-year-old children prevalence appears to have fallen, but worryingly this was not observed for children attending disadvantaged schools. A study from Trinity College Dublin suggests change can also be achieved within this age group. I understand this work was presented to the special action group on obesity. How will it be progressed and what actions and steps will be taken by the Minister and the Department?

The Department of Health has worked with the Broadcasting Authority of Ireland on publishing a new children's code, which aims to restrict the marketing of unhealthy food and drinks until 7 p.m. At what stage of progression is the children's code? The HSE has begun work on the development of a hub and spoke model of treatment for children who are obese. How many teams are in place? Are there are waiting lists for these services?

I would have liked to say more but the bell is ringing and I must cease. I thank the Minister for taking the statements today. I ask him to reflect on the point I made earlier that we should frame this not solely on the basis of obesity, but on the basis of healthy living and eating which affects more than those who may present as obese.

Photo of Mary Ann O'BrienMary Ann O'Brien (Independent)
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Food is pervasive, ubiquitous and cheap, with junky calories attractively cleverly packaged and delivered to us today in vast portions and quantities which would have been unimaginable 20 or 30 years ago. Today, we live in food swamps. I listened to Senator Thomas Byrne who referred to white bread, processed food, two litre bottles of fizzy drinks, giant super-sized bags of crisps, boxes, packets, and instant vending machines conveniently located. We have a national health crisis and I am very glad the Minister is here today. Other Members have spoken very well and we must in our time do something about this. It is a very complex issue and five minutes is only a couple of seconds in my lifetime to settle on a few points.

I heard the Minister say the World Health Organization's thoughts on 2030 may not be correct and it may be a little bit of fantasy, but Irish females seem to be most at risk of making Ireland the most famous country in Europe as we will be the fattest girls in Europe. Will the Minister write to the Minister with responsibility for sport and ask that we please encourage girls' sports among schoolchildren? My daughter who is, thank God, very sporty is in a beautiful school in Kilkenny which is very academic but is very bad at sport. There is volleyball, swimming and dancing, but it is all about boys and rugby, football and soccer. There is very little about girls. Once girls leave primary school, we have a real problem.

I did a little research last night because I thought, before I came in to speak about processed cardboard with no nutrition that tastes good and is instantly easy to serve with no stress and is cheap and quick, that I would go out and try to do a little shopping. I went to a supermarket on the way home. I know the Minister is a fairly busy man. I do not think he has a family, so he is not in supermarkets looking for deals on food to make meals as I am. I have loads of hungry people still living with me at home. I will share with the Minister all about the two litre bottles of fizzy drinks which are on special, with three for €4. Big giant packets of crisps were also on special, down to €1 which is half price. For €2.33 one could buy 1,826 calories, which is €0.44 per 100 g or €0.12 per 100 ml. Then I dropped into a fast-food restaurant. I had kept the receipt from the supermarket and there was a deal on the back of the receipt to send me to the fast-food restaurant. It cost €3.90 for a big hamburger, medium chips and a medium Coke. "Oh my God," I said delightedly about my €3.90, "what could I get for that?" I got 1,140 calories. I do not have time to tell the Minister about the fat and sodium.

This is a quick touch of reality about the job ahead for the Minister. The United States had this problem, and we used to think about the poor Americans who were so obese. We would travel there and speak in secret voices about the terrible problems the Americans had. They had a cold but we have pneumonia. We have embraced all of their problems. The year 2030 is a long way away in a political career but the Minister must be strong. I heard what he said in his closing speech and I was very pleased. He said the Government, local government, food industries, sport and recreation, communities and the media must all come together. The Ministers with responsibility for health, children, education, agriculture, sport, media, communications, the environment and tourism and the Taoiseach all need to come together urgently.

All the Senators have spoken very beautifully today, including my colleague, Senator van Turnhout, our eminent medical colleague, Senator Crown, and Senator Hayden, who was nearly more medically able in her speech. It was just brilliant.

How can we get our society to go back to healthy habits? To me, it is simple. Everyone here who knows anyone with an obesity problem should consider how their grandparents ate. Can they all just take a knife and fork and eat three times a day? Can they just go to the supermarket and buy either chicken, fish or eggs, which are a good source of protein and very low in cost? They should buy vegetables, fruit and potatoes and cook. It comes back to educating our children. Can we go back to school lunches and go back to the Minister for Education and Skills and make serious rules that there is nothing but healthy food allowed into schools? Can we educate mothers who are already obese themselves and do not know what to pack in those lunch boxes? Can we make cooking fun? Can little people in primary school be taught how to make simple things? Can we show them where food comes from by getting Bord Bia and the Department of Agriculture, Food and the Marine involved? Grow It Yourself Ireland's website worked in conjunction with Innocent, the lovely company that makes the little smoothies, and they have had 20,000 schoolchildren growing little seed boxes and bringing them home so they know from where healthy foods comes.

We often speak here about child benefit and we used to have those awful words "food stamps". What about health stamps? What about giving some of our less well-off citizens something very easy such as health stamps so they can go in and buy chicken, fish, porridge, vegetables, fruit and potatoes? What about colour-coded food labelling? We can talk about food labelling but people do not have time to figure them out.They are incredibly confused. I am in the food business and, believe me, we are clever cats. We are very good at marketing. It needs to be absolutely bog standard that green is good for you and red means only a little treat at the weekends. We must establish nutrition standards for food sold by food manufacturers, distributors and caterers who cater to our hospitals and schools.

Photo of Hildegarde NaughtonHildegarde Naughton (Fine Gael)
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I welcome the Minister. There are two points I wish to make in this debate. The first is that education is key to preventing childhood obesity and the second is that tackling obesity requires support for those who are affected. We have increasing rates of type two diabetes, especially in younger people. We also have increasing rates of cancer. According to Professor Donal O'Shea, the country's foremost expert in the area, 80% of the diabetes cases and 40% of the cancers are obesity-related. This is a very worrying statistic. It is also worrying that Ireland as a country is moving towards American obesity rates and body shapes and the associated illnesses. A total of 23% of Irish adults are reported to be obese, and 61% are either obese or overweight. The prevalence of overweight and obesity among Irish children is also considerable. The 2005 national children's survey, which measured the weight and height of children from age five to 12 years, found that the prevalence of excess weight was at 11% in Irish boys and 12% in Irish girls. The prevalence of obesity was 9% in boys and 13% in girls.

As the Minister has stated, one in four primary school children and one in five teenagers are overweight or obese. This is truly shocking and we are storing up huge problems for the future. I imagine every teacher in the country would tell the same story - that the children they teach are getting heavier. The cause of obesity in most cases is straightforward, particularly so with children. They take in too many calories and do not expend those calories in exercise.

Childhood obesity has more than medical effects. It also has psychological and social ones. Children nowadays are suffering illnesses they never had in the past, with high blood pressure and cardiac problems. The sad thing is that it can be so easily avoided if they do not develop bad habits when they are young.

Anyone of my generation or older will remember, as Senator Aideen Hayden mentioned, a very active after-school lifestyle. There was no PlayStation, and very little television or any other electronic distraction, and children were sent outside to play with their friends. Nor was there a lot of junk food. I have no complaint about the advance of time or technology, but we need to take what worked well in the past and encourage our children to engage far more in an active lifestyle before it is too late.

Every vending machine or tuck shop supplying junk food or sweets should be banned from schools. I acknowledge that the child obesity campaign is promoting healthy options in vending machines in post-primary schools. However, it is reported that 30% of schools still offer junk food. It could be stopped with a single stroke of the pen by the Minister for Education and Skills. The HSE is on record as saying it would welcome such a move. If there are cost implications, so be it. The economy is in full recovery mode and not doing so would be penny wise and pound foolish.

While education might not be the key for adult sufferers of obesity, it is for children. If we educate children about healthy eating and exercise it will benefit everyone. It will benefit future generations but also, perhaps, have an effect on parents. Given the right education, our children could in turn educate their parents in better lifestyle choices. We are all familiar with being shamed into action by a younger generation.

While adult suffers of obesity usually know full well the reason for their condition and its cure, it is often difficult to change a pattern of behaviour. The Atkins diet or similar diets are only a temporary solution; lifestyle change is key. Often, the underlying cause of overeating or inactivity is emotional. To alter that cycle, people need support and encouragement. I do not just mean helpful friends. Breaking the link between food and happiness often requires psychological intervention by trained professionals. It should be available where it is needed. These issues are complex and they require a societal response. They require State action in education and prevention but they also require personal responsibility and an acknowledgment that we are heading down a dangerous path, individually and collectively.

I am glad to note that work has commenced on a new obesity policy and action plan, which is due to be finalised later this year. I would urge a strong emphasis on the education of our young people. We are sitting on a ticking time bomb and if we do not take serious action we are at risk of an obesity crisis that will affect our people and health services long into the future.

Photo of Paschal MooneyPaschal Mooney (Fianna Fail)
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As many valuable contributions have been made, I will not repeat any of the statistics which, quite frankly, are appalling, particularly in the context of Ireland. I know the Minister is aware of this, not only because of his obligations as a Minister in the Department of Health but also because of his background as a medical doctor, in which he would have seen at first hand the consequences of obesity. One or two things that have emerged from these discussions is that the food industry has a very important role to play in this area. About 20 years ago a product appeared on Irish supermarket shelves, called something like sunshine orange.

Photo of Mary Ann O'BrienMary Ann O'Brien (Independent)
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Sunny Delight.

Photo of Paschal MooneyPaschal Mooney (Fianna Fail)
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Did the Senator refer to it?

Photo of Paschal MooneyPaschal Mooney (Fianna Fail)
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For those who are not aware of it, Sunny Delight emerged as a drink for children. It was placed in the refrigeration cabinets of Irish supermarkets, not on the drink shelves. It was put there quite deliberately and mischievously by the food industry. It was sugared water coloured orange. The sugar content was so high that it was obscene. I am not sure whether it is still a product on supermarket shelves, because my children have grown older, but I was very much aware of it when they were younger. It was an indication to me - it has been repeated in the food industry - of mischief-making by the food industry, which pays lip service to the whole question of obesity but will then draw back and say it has nothing to do with it. It has everything to do with the food industry. I could not help but recall a statement made by Irish scientist, Sir Stephen O'Rahilly, professor of clinical biochemistry and medicine and director of the Metabolic Research Laboratories at Cambridge University, who said:



It seems unarguable that excessive caloric consumption is playing a major role in driving the increasing prevalence of obesity. [That is self-evident]. It is helpful to get a well-informed semi-quantitative estimate of the sorts of overall reduction in calorie ingestion we would need to return obesity levels to those found in the 1980s. It would be optimal if the food industry became helpful partners, not adversaries, in countering the obesity epidemic. It is less likely to do so if hectored about substantially slashing its profits.
That is a very real concern, despite the fact that it may appear as though I am hectoring the food industry.

Research has shown that reducing body mass index, BMI, to 1980s levels in the UK - I assume the same applies here as the statistics are very close - would require an 8% reduction in consumption across the country. That in itself seems to be a modest reduction, but it would cost the food industry approximately €8.7 billion per year. Is there any incentive for the food industry? It seems not. That suggests to me that the legislative framework may have to force the food industry to act, and perhaps this could start the debate about labelling, which has been ongoing in Europe. Clearly, the food industry manages to obfuscate the interpretation the consumer is likely to put on food labelling in their efforts to discover whether a food is good for them or for their children. For example, writing "sodium" instead of "salt" is one way of disguising what is within a food. The food industry has fought tooth and nail against common positions in the European Union. It is like the smoking lobby. It is probably the most powerful lobby out there. As Professor O'Rahilly, has said attacking the food industry is a waste of time but certainly there is a need to draw it in. Perhaps the Minister will comment on that.

I acknowledge that a number of major food retailers are beginning to take the issue a bit more responsibly. For example, in recent years, Marks & Spencer has reduced the salt content of many of its food products. Some of them had a very high salt content. Nestlé in America has been forced to reduced its salt content. Obviously the food industry is aware of consumer pressure.Therefore, the question arises as to where a balance can be achieved between harnessing that consumer pressure and Governments discharging their responsibilities to ensure their citizens do not continue to be unhealthy. The cost of obesity to the Irish health sector is quite appalling. The safefood study on the cost of overweight and obesity found that direct health care costs linked to excessive weight in the Republic add up to €400 million, which is 3% of total health spending. However, this is dwarfed by the €729 million in indirect costs caused by absenteeism at work.

I do not have any simple glib answers, but I agree with those who said schools should be targeted. It is totally unacceptable, as Senator Naughton said, that 30% of schools are still churning out junk food. I do not want to name a former Member of this House, but when I raised the issue of obesity ten or 15 years ago and said snacking and providing crisps and biscuits to school pupils was unacceptable he said there were plenty of calories in them. He was a representative of the teaching profession. I was appalled and could not believe what he said. Maybe attitudes have changed; I hope they have and that the teaching profession is very much aware of its importance and responsibilities to the children in their care during the school day. That is a place to start.

I always remember as a very young boy my father regaling me with stories of when he was a young boy. When he went to primary school in the 1920s and 1930s physical education was part of the curriculum, but that is now gone. Our party is proposing that schools try to encourage more physical activity and free play areas. I am interested in hearing the views of the Minister on this. Should PE, for example, be part of the curriculum? Should it be mandatory at primary level that half an hour a day be given over to physical activity? It may not prove popular with children, but it seems to have worked for previous generations. I wish the Minister well in dealing with what is a very complex problem that needs to be addressed.

Photo of Michael MullinsMichael Mullins (Fine Gael)
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I welcome the Minister and thank him for spending so much time here this afternoon to discuss this very important issue. It has been described as a crisis and one of the major health issues of our time which consumes a lot of the resources available to the health services. The figures which have been referred to are startling. I recently spoke to a primary school teacher who teaches fourth class. As part of her efforts to improve English and creativity she got the children to design a menu for an evening meal. It produced some startling results. The children who came from the lower income categories had a totally different type of menu for an evening meal than those from higher income groups. It is an area we have to address.

The Irish Heart Foundation recently published some research into food provision in the country's second level school that shows there is a very high availability of unhealthy foods. Foods high in fat, sugar and salt were available in more than half of the 39 schools that took part in the survey and around 40% of the schools did not make water available free of charge. While 37% provided full hot meals, over 70% provided snacks that included sausage rolls, pizza slices and panini, foods which are high in fat and salt. Some 25% of schools still have tuck shops and 47% have vending machines. We need to have some discussions with the Minister for Education and Skills on how the provision of healthy food in schools can be addressed.

Many contributions have referred to information, labelling and how we tackle the food companies which are making some of this food very attractive and selling it at a very low price. We need to get information on food and nutrition and how to prepare good nutritious meals on limited budgets across to parents. There is great respect for celebrities in this country. We have a lot of very fine chefs. We should spend some of our resources on producing programmes for television or online media on how to tackle obesity and prepare nutritious meals at a reasonable cost. Many people feel if they spend money on fast food that it is cheaper, but if parents had the wherewithal to cook food they would be surprised at the savings which could be made. We need to sell the message.

There is an increasing awareness in the country of the need for more physical activity. It is fantastic to see many people cycling and walking, but we need to significantly increase those numbers. I refer to the bike to work scheme, whereby some tax relief was given to people who bought a bike with a view to cycling to work. We should consider the possibility of reducing the level of tax on bicycles for children so as to encourage them to cycle and get more exercise. That could be done at a fairly reasonable cost to the Exchequer, but would have long-term and far-reaching benefit.

We distribute a large amount of grants on a very regular basis to all communities the length and breadth of the country. I would like to see those grants linked in some way to the level of usage by young people of sporting and recreational facilities. I would make it mandatory that programmes are geared towards ensuring young people get a minimum level of exercise per week. We would all love to see schools doing more in terms of recreation and exercise, but it is a major challenge for many schools, some of which do not have the facilities. The school day is crammed with other academic activities and it is difficult to make time for other things.

The onus should be on communities to play their part. We have a major problem on our hands, but the Minister is heading in the right direction. I would like to see action on the various reports that are now becoming available. We should soon put an end to the consultation process and start to put in place measures that will tackle this problem for once and for all and make a serious impact on the level of obesity and ill health that is emerging in our population which will have major implications for our health budget in the future.

Photo of John CrownJohn Crown (Independent)
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I beg the indulgence of the Minister. I wish to make another point. I do not think it would undermine the principles of community rating if we put a policy of incentives in place regarding private health premiums to incentivise healthy behaviours and lifestyles. Somebody cannot choose not to be old, therefore we as a community decide to rate them in the same way as we rate young people for health insurance, which is correct. Somebody cannot choose his or her family history, therefore it is fair that people can benefit from community rating and not be undermined in the event that they have an adverse genetic endowment which could potentially leave them with a higher risk of suffering from a potentially expensive illness.

People, however, can make certain decisions with respect to their lifestyle. During his term, would the Minister consider examining the possibility of certain incentives whereby non smokers or people with a certain BMI could get a discount on their health insurance premiums? These are all things which are attainable for everybody. Everybody can stop smoking if they try hard enough.

Photo of Leo VaradkarLeo Varadkar (Minister, Department of Transport, Tourism and Sport; Dublin West, Fine Gael)
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I thank Senators for the invitation to be here. I have had the opportunity to listen to some of their statements and points of view and in many ways, this is part of the consultation on the obesity policy and action plan announced earlier. In that regard the debate is very helpful. I agree with Senators' sentiments that the consultation should not go on forever - it will not - and it is my intention to publish the policy and, more important, the action plan before the end of the calendar year.

There are some issues that I should pick up that were mentioned by Senators. The healthy eating guidelines are being revised this year and will address some of the specifics, such as bread types, pasta and so on, as mentioned by Senator Byrne earlier. There will also be a communication strategy to support the new healthy eating guidelines. The Department of Health is currently working with the Department of Education and Skills on a whole-school approach to healthy eating, including advice and training for children on helping to cook healthy food, as well as supporting the existing "Food Dudes" programme, with which some Members would be familiar. It deals with fruit and vegetables and is working very well. The issue of bariatric surgery was raised. In 2014, there were 22 surgeries done in Galway and 20 done in Dublin. This year, in addition to those in Galway there will be 50 in Dublin and 80 next year. We are making additional provision for more bariatric surgery this year and again next year. Unfortunately, as with many issues, demand is rising. That is not necessarily because supply is not increasing, as it is, but demand is increasing also.

With the new GP contract, children will be weighed at ages two and five. This does not need to come at a dedicated visit and it is something that doctors can do opportunistically when the kid is visiting for something else anyway. Many GPs do it anyway but it is important. I have heard some people say this approach is not evidence-based but we know from evidence that just guessing somebody's weight is appallingly inaccurate. It is important, if they are not doing it already, that GPs should weigh children and see if there is an issue around obesity. This can lead to an opportunity for early, brief intervention by the doctor in giving the parent advice on what can be done to reverse a child's obesity.

I am not exactly sure how access to a dietitian would work and I imagine it would depend on the availability of dietitians in the primary care centre or the local health centre. The fees, if there are any, would not be covered by the under-six contract. Taxation is ultimately a matter for the Minister for Finance and not for me. It is also ultimately a matter for the Oireachtas but the proposal must come from the Department of Finance for any new tax or increases in taxation. Generally speaking, the Department of Finance now and historically has not been well disposed towards hypothecation of taxation; it does not like ring-fenced taxes at all. That is for the obvious reason that people are always willing to ring-fence a tax for something popular or desirable but getting people to agree to ring-fence a tax for asylum seekers or Traveller accommodation etc. would be harder. The general view is that the best principle is for tax to go to the one pot and the money is prioritised for spending thereafter. Should the Department take a different view, I would very much welcome hypothecated taxes going towards public health.

I expect to have the draft heads of the Bill dealing with calories posting on menus by November for consideration by the joint committee, with a memo for the Government by the end of the year. That would cover both calorie posting and health and well-being in the workplace. I would like the workplace to get to somewhere like the current position with health and safety. Ten years ago, health and safety in the workplace was rubbish but people were very annoyed about having to do health and safety statements etc. Now, people very rarely die in the workplace when people died or were injured all the time at work. I would like to see a similar process begin with health and well-being, encouraging and, in due course, requiring employers to make their workplace a healthy place and take well-being seriously there.

The Broadcasting Authority of Ireland is currently revising its marketing code for 2016 and we are making a submission as a Department to that. In particular, we are seeking the advertisement to be extended. It is now 6 p.m. and we are asking the authority to extend it to 9 p.m., and I would welcome the support of Senators in that proposal. We want to strengthen the code of practice, particularly when it comes to marketing in the non-broadcast media, product placement and retail outlets. There is also the issue of food sponsorship.

I like and would welcome colour-coded food labelling. It is done voluntarily by some food manufacturers, and one sees it in particular in Marks & Spencer, for example, and it is being done by many food producers in the UK as part of the responsibility deal. I would like to see this happen more in Ireland, although it is not something we can impose by law as food is traded across the European Union and it would be a barrier to trade. It is something that would have to be done on a European level or we would have a difficulty with Irish-produced food not being allowed to be exported, which would be problematic.

I could be wrong but my understanding is that physical education is mandatory in schools. Students may not always get the hours they are supposed to but it is mandatory. A positive aspect of the reform of the junior certificate curriculum being implemented by the Minister for Education and Skills, Deputy Jan O'Sullivan, is that the subject of well-being will be core to the new cycle. It will include elements like sport, physical activity, nutrition and health advice. It will be a good step forward. I would like to see physical education being examined for the leaving certificate. That is done in other countries and it would be a good move here.

The Department of Education and Skills is also working on a new school food policy that is currently being prepared and it will address issues such as vending machines and tuck shops. I know the Minister, Deputy O'Sullivan, has a particular interest in that. Some schools have healthy vending machines and I know Luttrellstown Community College near me has one; I took a photograph of it the other day. I had not seen one before and I found it quite interesting. It is not necessarily a case of not having vending machines.

Photo of Aideen HaydenAideen Hayden (Labour)
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What is in a healthy vending machine? It is hard to get good food quickly.

Photo of Leo VaradkarLeo Varadkar (Minister, Department of Transport, Tourism and Sport; Dublin West, Fine Gael)
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There were crisps on the top rung but the rest of it was okay. It is not that we cannot have vending machines but a case of what is put into them. The school food programme is coming up a lot in discussing the obesity policy and we hope to address matters such as food poverty, the healthy provision of food in schools and the education of children. We will engage with the Department of Education and Skills on the policy and Senators have touched on how important it is to do that.

Senator Noone mentioned maternal obesity and it is acknowledged that this is a problem. Very often, obesity starts before conception and in the womb, in some ways. That is going to be a key element of the new clinical guidelines being developed by the Royal College of Physicians in Ireland in consultation with the HSE. A key action that could make a big difference is breast feeding, the rates of which in Ireland are very low and much lower than they should be. It is something that we would like to push in the next couple of years. This should not just be advice around breast feeding but dedicated midwifery positions to help women to breast feed if they are having difficulty.

Senator Crown and I have engaged before in this Chamber on modifications to lifetime community rating. There could be a discount for non-smokers or people with a body mass index, BMI, under 30. BMI is not everything and extremely healthy people with a decent amount of muscle mass can have high BMI but that does not mean they are obese. Any discount, by definition, must result in a loading for somebody else and we would have to consider the implications of loading health insurance policies for people who are obese, smokers or so on. We could then be returning to the inverse care law, where health insurance is more expensive for those who perhaps need it most and less expensive for those who do not. This must be thought through.

I am particularly pleased that there was a good level of agreement across the Chamber in how to address the issues and experience tells us that there is a variety of ways in which all sectors can contribute to tackling obesity. Both obesity and people being overweight are major public and personal health concerns, particularly in children and those with chronic diseases. I have outlined some of the measures under way and we will continue to add to and strengthen these. Obesity is not a simple issue and its causes are complex and its solutions whole-of-Government and whole-of-society approaches. My Department and I are determined to develop a robust and comprehensive obesity policy and action plan under the Healthy Ireland framework this year and drive the implementation in future.

Sitting suspended at 4.50 p.m. and resumed at 5 p.m.