My Speech on Childhood Obesity

 

As this House is well aware, I have long been a strong and vocal advocate for the urgent need to tackle the growing obesity epidemic – especially childhood obesity.

The prevalence of obesity has rocketed in Ireland in recent times, with 61% of adults (a rise of 17% since 1998) and 25% of children currently overweight or obese.

There is no disputing that Obesity is a major public challenge, particularly in regard to diabetes and cardio vascular disease and the significant burden it places on health spending. The rate of obesity has increased at such an alarming speed that the World Health Organisation (WHO) has pronounced it a global epidemic.

In fact one of the most recent reports compiled by the World Health Organisation on the issue predicted Ireland was on course to be the fattest nation in Europe by 2030.

According to A Healthy Weight for Ireland- Obesity Policy and Action Plan 2016-2025:

Prevalence of overweight and obese children was higher in schools in disadvantaged areas than in other schools.In the most deprived areas just over one in four people aged 15 and over is obese, compared to less than one in six in the less deprived areas. The direct and indirect cost of obesity in Ireland is estimated at around €1.13billion

As has been highlighted by several experts in recent years – sugar consumption is one of the main culprits not only in obesity but also in level of tooth decay among young children.

In fact the level of tooth decay has been described by Dr Anne Twomey, vice-president of the Irish Dental Association as catastrophic. An alarming number of young children and babies are developing cavities and decay at a very early age.

According to a report from the Royal College of Surgeons in the UK, extractions among children under the age of five have risen by almost 2,000 a year in the past decade. Experts say a combination of poor diet and too much sugar is to blame.

When you see the numbers adding up like this, it becomes clear that the sweet habits of our children are having a devastating effect both on their weight and on their oral health

The fact that children in this country as young as one or two need to have teeth extracted is shocking. It’s almost certain that the majority of these extractions will be down to tooth decay caused by too much sugar.

A 2015 study by the Irish Dental Association found that some 10,000 extractions were carried out every year – and that most of these were due to too much sugar in diets,

According to Dr Twomey,  although parents are responsible for what they feed their children – it’s not entirely their fault: some are mistakenly buying products they believe are healthy such as yoghurts and follow-on milk .

Ensuring sugar more expensive is one way to help prevent cavities in children, combined with more information for parents.

Although I have warmly welcomed the introduction of the Obesity Policy and Action Plan with measures such as calorie posting on restaurant menus, food labelling and the introduction of healthy options in school vending machines- I believe more can be done.

Whilst school food accounts for a growing proportion of children’s food intake – it is not subject to any national guideline or standard despite the identification of obesity as a major threat to the current and future health of this generation of children. The haphazard approach to food provision also extends to the State-funded School Meals Local Projects Scheme and the School Completion Programme. These are excellent programmes in many respects, but incorporate no mandatory requirement for the supply of healthier food options and there is monitoring of the quality of food provided.

The Irish Heart Foundation 2015 research ‘Food Provision in Post-Primary Schools’ examined what second level students are eating; models of food provision; and whether national standards are needed, or wanted by school authorities.

The research found that 37% of schools offered full hot meals and 37% offered cold snacks like sandwiches, nearly 70% of schools offered hot snacks including sausage rolls, pizza slices and paninis. A quarter of schools had tuck shops and 47% had vending machines.

A follow up seminar (Spring 2015) attended by school caterers, teachers, nutritionists and public health experts produced a strong consensus that unhealthy food can be removed completely from school campuses, delivering a massive health dividend for children without necessarily impacting negatively on school income sources, or on already hard-pressed teachers and school managements.

At this point I would like to address the issue of the Marketing of foods high in fat, sugar and salt to children – both digital and on TV but also in non-broadcast media such as commercial sponsorship in schools and codes of practice in shops and supermarkets

 The Stop Targeting Kids petition is the latest step in Irish Heart’s fight to protect children from obesity following research published last summer entitled: ‘Who’s Feeding the Kids Online’.

In that report, The Irish Heart Foundation exposed how junk food companies were deliberately targeting children in a much more individualised way online than they ever could through television advertising, using hi tech analytics to target children directly.

Using analytics, multinational companies can identify those who are most reactive to food and drink marketing and extract huge amounts of personal information about individual children: who they are, where they live, where they go, what they do, what they like, what their hobbies are and what their friends tag them with.

Armed with this information junk food marketers use the 3Es – powerful engagement, emotional and entertainment based tactics to connect with children online. This is based around a strong emphasis on fun and humour, on special days, links to entertainment, festivals, sports and other events. They also regularly feature sports stars and celebrities popular with children.

It is imperative therefore, we protect children’s health through strict controls, particularly on digital marketing, which remains unregulated in spite of clear evidence of its powerful influence over children’s food choices.

What I believe can be done:

A ban on television advertising, product placement and sponsorship of food and drink that is high in fat, salt and sugar (HFSS) from 6am to 9pm.

Introduction of a statutory regulatory system for online and digital advertising / marketing of HFSS food and drink directed at children.

Designate schools as ‘protected environments’ free from all forms of marketing of HFSS foods, including commercial sponsorship.

Develop a code of practice to control placement of unhealthy foods at toddler and child level and at checkouts.

Restrict sponsorship by foods HFSS of children’s sporting activities to under 18’s.

Limit the provision, sale and advertising of fatty snacks, confectionery and sweet drinks in public institutions such as schools and hospitals.

At this point, I would like to address the difficulties of eating nutritious food on a low income and how we can make healthy food available and affordable for families on low incomes

The latest results from Childhood Obesity Surveillance Initiative (COSI) in Ireland reveals higher level of overweight and obesity in children from lower socio-economic backgrounds. Those attending DEIS schools tend to have higher levels of overweight and obesity than those attending other schools and the gap becomes wider as children get older.

The Growing Up in Ireland study further reinforces this, showing that social inequalities increase the risk of overweight and obesity from an early age. It finds that some aspects of diet are differentiated by social advantage: consumption of fruit and vegetables was highest among children from more advantaged families while energy dense foods, such as chips, pies, sausages etc., and soft drinks, were consumed more often by young people from more disadvantaged homes.

One of the driving forces behind higher rates of obesity and ill-health in the worst off communities is food poverty – the inability to have an adequate and nutritious diet due to issues of the affordability of and access to food.

Although food poverty influences the way obesity is distributed across society – I believe the link has not been so far recognised by policymakers. It is ignored in population health measures that provide greater benefit to families from more affluent communities and effectively exclude families focused on staving off hunger rather than feeding their children well.

This government has a duty to support disadvantaged communities to realise the benefits of Family Food Initiatives (FFIs). FFIs can help families have access to healthier food and to empower them to make informed food choices that will have a knock-on effect on their long-term health outcomes.

Potential actions I believe this government can take include:

Considering ways of making healthy food accessible and affordable for people on low incomes, including funding for community food initiatives, and cooking and nutrition education.

Actions to address the social determinants of health and to reduce health inequalities, such as incorporating health impact assessments and health equity impact assessments into all policy and funding decision-making at national and local level and providing a certain percentage of the national health budget to action on social determinants of health (across health and other sectors).

In my view, these measures would have a very positive effect on obesity levels.

However, the fact remains that once obesity has developed, treatment can often be unsuccessful.  As such, I believe even earlier prevention efforts are also urgently required.

To date, the World Health Organization, Obesity

Canada, the U.S. Institute of Medicine and the U.K. government have all acknowledged maternal obesity and pregnancy as primary targets for prevention of downstream childhood obesity.

 A 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 7 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.

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 entitled: “Trends in maternal obesity 2009–2013” revealed that:

1 in 6 women presenting for antenatal care is obese

1 in 50 are morbidly obese

The number of severe obesity cases increased by 48.5% over the time period

These statistics were taken from a study of over 40,000 women through the Coombe from 2009-2013

 So 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.

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.

 The following measures, I believe, could be implemented to curb the growing trend of maternal obesity in Ireland – they 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.

Adopting 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.

Finally, during my tenure as Senator, I have suggested numerous measures on how to tackle childhood obesity but also obesity and health in general and I would be interested in the Minister’s view on these additional proposals:

Most recently, I I have called for increased funding for subsidised cycle lanes and purchase schemes – a report, carried out by experts from the University of Glasgow over five years, showed that 46% of those who cycled to work lowered their risk of cardiovascular disease and 45% lower risk of developing cancer than people who drive to work or take public transport.

The research concluded that overall cyclists have a 41% lower risk of premature death from any cause. This is a hugely significant percentage. These findings strongly indicate that policies designed to make it easier for people to commute by bike, such as increased funding for subsidised cycle purchase schemes and cycle lanes are making a significant difference.

 

I have also called for calorie counts on menus to be made mandatory in all take away food outlets. A Stanford Business School conducted research on Starbucks where calorie counts were implemented and found the whilst revenues were not affected, calories per transaction fell by 26%.

 

I have also called for healthy options to be made available in for vending machines in secondary schools and in all Government Departments.  I believe this is the way forward  – moreover, other workplaces, and particularly hospitals should follow suit.

I have also advocated for Schools and pre-schools to become sweet-free zones

To conclude – there is no denying that Obesity epidemic is a major public challenge, particularly in regard to diabetes and cardio vascular disease and the significant burden it places on health spending. Every initiative that has the potential to lessen this encumbrance on our nation’s health and finances must be considered.

Obesity Speech.

 

As this House is well aware, I have long been a strong and vocal advocate for the urgent need to tackle the growing obesity epidemic – especially childhood obesity.

 

The prevalence of obesity has rocketed in Ireland in recent times, with 61% of adults (a rise of 17% since 1998) and 25% of children currently overweight or obese.

 

There is no disputing that Obesity is a major public challenge, particularly in regard to diabetes and cardio vascular disease and the significant burden it places on health spending. The rate of obesity has increased at such an alarming speed that the World Health Organisation (WHO) has pronounced it a global epidemic.

 

In fact one of the most recent reports compiled by the World Health Organisation on the issue predicted Ireland was on course to be the fattest nation in Europe by 2030.

 

According to A Healthy Weight for Ireland- Obesity Policy and Action Plan 2016-2025:

 

Prevalence of overweight and obese children was higher in schools in disadvantaged areas than in other schools

 

In the most deprived areas just over one in four people aged 15 and over is obese, compared to less than one in six in the less deprived areas

 

The direct and indirect cost of obesity in Ireland is estimated at around €1.13billion

 

As has been highlighted by several experts in recent years – sugar consumption is one of the main culprits not only in obesity but also in level of tooth decay among young children.

 

In fact the level of tooth decay has been described by Dr Anne Twomey, vice-president of the Irish Dental Association as catastrophic.

 

An alarming number of young children and babies are developing cavities and decay at a very early age.

 

According to a report from the Royal College of Surgeons in the UK, extractions among children under the age of five have risen by almost 2,000 a year in the past decade. Experts say a combination of poor diet and too much sugar is to blame.

When you see the numbers adding up like this, it becomes clear that the sweet habits of our children are having a devastating effect both on their weight and on their oral health

The fact that children in this country as young as one or two need to have teeth extracted is shocking. It’s almost certain that the majority of these extractions will be down to tooth decay caused by too much sugar.

A 2015 study by the Irish Dental Association found that some 10,000 extractions were carried out every year – and that most of these were due to too much sugar in diets,

According to Dr Twomey,  although parents are responsible for what they feed their children – it’s not entirely their fault: some are mistakenly buying products they believe are healthy such as yoghurts and follow-on milk .

Ensuring sugar more expensive is one way to help prevent cavities in children, combined with more information for parents.

Although I have warmly welcomed the introduction of the Obesity Policy and Action Plan with measures such as calorie posting on restaurant menus, food labelling and the introduction of healthy options in school vending machines- I believe more can be done.

Whilst school food accounts for a growing proportion of children’s food intake – it is not subject to any national guideline or standard despite the identification of obesity as a major threat to the current and future health of this generation of children. The haphazard approach to food provision also extends to the State-funded School Meals Local Projects Scheme and the School Completion Programme. These are excellent programmes in many respects, but incorporate no mandatory requirement for the supply of healthier food options and there is monitoring of the quality of food provided.

The Irish Heart Foundation 2015 research ‘Food Provision in Post-Primary Schools’ examined what second level students are eating; models of food provision; and whether national standards are needed, or wanted by school authorities.

The research found that 37% of schools offered full hot meals and 37% offered cold snacks like sandwiches, nearly 70% of schools offered hot snacks including sausage rolls, pizza slices and paninis. A quarter of schools had tuck shops and 47% had vending machines.

A follow up seminar (Spring 2015) attended by school caterers, teachers, nutritionists and public health experts produced a strong consensus that unhealthy food can be removed completely from school campuses, delivering a massive health dividend for children without necessarily impacting negatively on school income sources, or on already hard-pressed teachers and school managements.

 

 

At this point I would like to address the issue of the Marketing of foods high in fat, sugar and salt to children – both digital and on TV but also in non-broadcast media such as commercial sponsorship in schools and codes of practice in shops and supermarkets

 

The Stop Targeting Kids petition is the latest step in Irish Heart’s fight to protect children from obesity following research published last summer entitled: ‘Who’s Feeding the Kids Online’.

 

In that report, The Irish Heart Foundation exposed how junk food companies were deliberately targeting children in a much more individualised way online than they ever could through television advertising, using hi tech analytics to target children directly.

 

Using analytics, multinational companies can identify those who are most reactive to food and drink marketing and extract huge amounts of personal information about individual children: who they are, where they live, where they go, what they do, what they like, what their hobbies are and what their friends tag them with.

 

Armed with this information junk food marketers use the 3Es – powerful engagement, emotional and entertainment based tactics to connect with children online. This is based around a strong emphasis on fun and humour, on special days, links to entertainment, festivals, sports and other events. They also regularly feature sports stars and celebrities popular with children.

 

It is imperative therefore, we protect children’s health through strict controls, particularly on digital marketing, which remains unregulated in spite of clear evidence of its powerful influence over children’s food choices.

What I believe can be done:

A ban on television advertising, product placement and sponsorship of food and drink that is high in fat, salt and sugar (HFSS) from 6am to 9pm.

Introduction of a statutory regulatory system for online and digital advertising / marketing of HFSS food and drink directed at children.

Designate schools as ‘protected environments’ free from all forms of marketing of HFSS foods, including commercial sponsorship.

Develop a code of practice to control placement of unhealthy foods at toddler and child level and at checkouts.

Restrict sponsorship by foods HFSS of children’s sporting activities to under 18’s.

Limit the provision, sale and advertising of fatty snacks, confectionery and sweet drinks in public institutions such as schools and hospitals.

At this point, I would like to address the difficulties of eating nutritious food on a low income and how we can make healthy food available and affordable for families on low incomes

The latest results from Childhood Obesity Surveillance Initiative (COSI) in Ireland reveals higher level of overweight and obesity in children from lower socio-economic backgrounds. Those attending DEIS schools tend to have higher levels of overweight and obesity than those attending other schools and the gap becomes wider as children get older.

The Growing Up in Ireland study further reinforces this, showing that social inequalities increase the risk of overweight and obesity from an early age. It finds that some aspects of diet are differentiated by social advantage: consumption of fruit and vegetables was highest among children from more advantaged families while energy dense foods, such as chips, pies, sausages etc., and soft drinks, were consumed more often by young people from more disadvantaged homes.

One of the driving forces behind higher rates of obesity and ill-health in the worst off communities is food poverty – the inability to have an adequate and nutritious diet due to issues of the affordability of and access to food.

Although food poverty influences the way obesity is distributed across society – I believe the link has not been so far recognised by policymakers. It is ignored in population health measures that provide greater benefit to families from more affluent communities and effectively exclude families focused on staving off hunger rather than feeding their children well.

This government has a duty to support disadvantaged communities to realise the benefits of Family Food Initiatives (FFIs). FFIs can help families have access to healthier food and to empower them to make informed food choices that will have a knock-on effect on their long-term health outcomes.

Potential actions I believe this government can take include:

Considering ways of making healthy food accessible and affordable for people on low incomes, including funding for community food initiatives, and cooking and nutrition education.

Actions to address the social determinants of health and to reduce health inequalities, such as incorporating health impact assessments and health equity impact assessments into all policy and funding decision-making at national and local level and providing a certain percentage of the national health budget to action on social determinants of health (across health and other sectors).

In my view, these measures would have a very positive effect on obesity levels.

However, the fact remains that once obesity has developed, treatment can often be unsuccessful.  As such, I believe even earlier prevention efforts are also urgently required.

To date, the World Health Organization, Obesity

Canada, the U.S. Institute of Medicine and the U.K. government have all acknowledged maternal obesity and pregnancy as primary targets for prevention of downstream childhood obesity.

 A 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 7 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.

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 entitled: “Trends in maternal obesity 2009–2013” revealed that:

1 in 6 women presenting for antenatal care is obese

1 in 50 are morbidly obese

The number of severe obesity cases increased by 48.5% over the time period

These statistics were taken from a study of over 40,000 women through the Coombe from 2009-2013

 So 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.

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.

 The following measures, I believe, could be implemented to curb the growing trend of maternal obesity in Ireland – they 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.

Adopting 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.

Finally, during my tenure as Senator, I have suggested numerous measures on how to tackle childhood obesity but also obesity and health in general and I would be interested in the Minister’s view on these additional proposals:

Most recently, I I have called for increased funding for subsidised cycle lanes and purchase schemes – a report, carried out by experts from the University of Glasgow over five years, showed that 46% of those who cycled to work lowered their risk of cardiovascular disease and 45% lower risk of developing cancer than people who drive to work or take public transport.

The research concluded that overall cyclists have a 41% lower risk of premature death from any cause. This is a hugely significant percentage. These findings strongly indicate that policies designed to make it easier for people to commute by bike, such as increased funding for subsidised cycle purchase schemes and cycle lanes are making a significant difference.

I have also called for calorie counts on menus to be made mandatory in all take away food outlets. A Stanford Business School conducted research on Starbucks where calorie counts were implemented and found the whilst revenues were not affected, calories per transaction fell by 26%.

I have also called for healthy options to be made available in for vending machines in secondary schools and in all Government Departments.  I believe this is the way forward  – moreover, other workplaces, and particularly hospitals should follow suit.

I have also advocated for Schools and pre-schools to become sweet-free zones

To conclude – there is no denying that Obesity epidemic is a major public challenge, particularly in regard to diabetes and cardio vascular disease and the significant burden it places on health spending. Every initiative that has the potential to lessen this encumbrance on our nation’s health and finances must be considered.

 

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