Minister Varadkar – Seanad Statement Obesity
Seanad Statement Obesity
Minister for Health – Leo Varadkar, T.D.
Check Against Delivery
A Chathaoirleach agus a Sheanadoirí
Thank you for inviting me to speak to you 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 wish to put the issue of obesity in context. At the moment, the Department of Health and the Minister of State, Deputy Kathleen Lynch, and I are pursuing 25 actions for this year around five major themes. They are Healthy Ireland, patient outcomes and safety, universal health care reform and the modernisation of our infrastructural facilities. We put Healthy Ireland first for a particular reason, because it is our belief that we need to improve our health as individuals, as that is in our own interest, but also we need to improve our health as a nation if we are ever going to get on top of the health problems we face in this country or ever get on top of health budgets. That includes lots of different actions.
The Healthy Ireland survey is now under way. It is the first survey of our nation’s health since SLÁN back in 2007.
Members will be aware of the actions taken by the previous Minister, Deputy James Reilly, and our forbearers on tobacco and the regulation of sunbeds, which was introduced in recent months to protect children in particular from skin cancer, and also the actions that are being taken on obesity.
Let me say at the outset: overweight and obesity are a major and a serious personal and public health issue in Ireland. Health information data from Growing Up in Ireland (2012), – COSI (2012), the Healthy Ireland Survey and many other sources confirm that two out of every three adults and one in four Irish children, is either overweight or obese. It is of great concern to me that Growing Up in Ireland states that one in four 3 year olds is also overweight or obese. Obesity affects all sections of society in Ireland. There is no other disease or medical condition that affects so many people in Ireland.
Furthermore, overweight and obesity are rising. It is estimated that overweight and obesity levels have doubled within the last 20 years and according to the latest projections from the World Health Organisation (WHO) the situation is likely to get worse. I will come back to the last point in the next few minutes.
We know that overweight and obesity is not just about the shape and size of one’s waist line. It is not just a cosmetic issue.
Overweight and Obesity are real medical and clinical issues. The World Health Organisation recognises this in its International Classification of Diseases.
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 II diabetes and dementia. Overweight and obesity contributes to about 30% of heart disease and cancers: Eighty percent of Type II Diabetes is associated with overweight and obesity. According to evidence it affects all of our systems and most of our body organs, whether it is endocrine, circulatory, respiratory system or organs such as liver, brain or pancreas.
In addition, overweight and obesity is a major economic burden on society. Safefood, in 2013, estimated the cost of obesity to the Irish Health Services to be €1.13 Billion. As well as this financial cost, there is also 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. In terms of loss of productivity, it is a burden on industry.
Addressing the challenges:
In 2005, my Department published The Obesity Taskforce Report. The report 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 thank all those who were involved.
When this Government came to power, my Department established a Special Action Group on Obesity (SAGO). The aim was to advise Minister Reilly, and now me, on 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 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 of little or no nutritional value to the consumer
- The commissioning of a Health Impact Assessment in relation to fiscal measures on sugar sweetened drinks
- The initiation of a National Physical Activity Plan for Ireland, soon to be launched
- With Safefood, a multimedia campaign to tackle childhood obesity
- The development of an EU Joint Action on childhood obesity which was initiated during the Irish presidency of the EU
- Additional funding was made available in 2015 to cater for an increased number of Bariatric Surgeries in Loughlinstown
- My Department has agreed a new contract with the IMO which will require GPs to weigh children at ages 2 and 5. This is an important measure as obesity in childhood has a higher risk of tracking into adulthood.
In addition, Industry are making some changes in relation to reformulating certain products, adjusting the size or portion of others and introducing new healthier options – all measures which I support.
My Department is currently developing heads of a Healthy Ireland Bill which will include calorie posting on menus. It has also assisted in food labelling, in the development of a number of treatment algorithms and clinical guidelines, providing for child monitoring in primary care, and worked with the Broadcasting Authority of Ireland on 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.
My Department and 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 many measures in train to address the major public health issue which obesity presents, it is important to point out that we have not, as yet, managed to reverse the trends. In fact the European Office of the World Health Organisation states that, if obesity is not addressed, all its Member States will see massive increases. Ireland, according to these predictions will be top of that league.
It is important to understand that the authors of the World Health Organisation 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 measurement but other countries had only reported data.
This is a very important distinction because most people, and a large number of clinical professionals, underestimate their weight. Secondly, the Irish data used is more than 7 years old and does not take into account the successful efforts that have been made in Ireland during that period. Thirdly, we have already published more recent data about childhood obesity, which gives us some grounds for optimism.
We all know that overweight and obesity develop over a long time. Everyone is at risk of developing obesity at any stage of their 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, has shown a reduction in obesity at the age of 7, from 6.2% in 2008 to 3.8% in 2012 and stabilisation at the age of 9, remaining around 5%. The results of The Growing Up in Ireland survey carried out in 2012 found that in children as young as 3 years of age, one in four are overweight or obese. The same group followed up at age 5 shows that this figure has reduced 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 disinterested by the facts.
Before I finish I want to point out the following. Obesity is not as simple as many people think. The risk factors are multiple and complex.
At its simplest form obesity is caused by the excess of energy intake over energy expenditure. The Foresight Group in the UK attempted to map out the various causes, risk factors and interactions and came up with over 90 different issues to be addressed. They grouped these into 10 different domains: medical, biological, technology development, infrastructure, food, activity, economic, social and media & 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.
The McKinsey Global Institute, looked at the issues and concluded, that firstly: it is high time to act and secondly: we must all act together, and third: that there is no one solution or game-changing action. However, McKinsey looked at seventy four interventions across eighteen groups and agreed that the most efficient and effective interventions can be grouped into seventeen actions including; 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 combined taxes and subsidies.
McKinsey emphasised that based on existing evidence any single intervention is likely to have only a small overall impact on its own. Mc Kinsey also acknowledged that a systematic sustained portfolio of initiatives, delivered at a scale, is needed to address the health burden of obesity. Almost all the seventeen interventions are cost effective for society.
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, food industry, sports & recreation, communities, media, voluntary organisations and so on; we 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 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; legislative, regulatory, health service related, educational and measures related to physical activity, sport, transport and planning.
My Department and I have initiated a consultation process on the National Obesity Policy and Action Plan.
In April 2015 a very productive consultation day was held in Farmleigh with 112 key stakeholders. 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, 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.
Senators, Ireland has a history of managing successfully and coming together to collaborate and successfully tackle high risk public health issues; whether it was fighting the infectious diseases like cholera, polio or TB in the past or the risk posed by smoking, and road traffic collisions more recently.
In the future, we need to treat alcohol misuse and overweight/obesity with the same degree of importance as we did these.