Childhood Obesity: Why the President can show leadership
Why should the President of Ireland lead the fight against child obesity?
Child obesity is the biggest threat to the health of our nation. Safefood research estimates that 85,000 children currently living on the island will die prematurely due to overweight and obesity. But efforts to combat this epidemic are being placed on the backburner behind the urgent demands of the health crisis -trolley numbers, waiting lists, and other scandals.
What I believe is there should be a whole of State response to tackle the complex drivers of obesity. This simply is not happening.
The President is ideally placed to provide moral leadership that transcends the politics of Irish healthcare and to be a focal point for comprehensive action by the State that’s so badly needed and to achieve the culture change that must go hand in hand with regulatory changes by Government and individual action by citizens.
Ideally, this would involve a figurehead role in aspects of the Government’s Healthy Ireland programme that require the mobilisation of the public and of public resources – areas such as increasing physical activity rates; promoting healthier eating particularly in disadvantaged communities; championing ‘whole of school’ healthy lifestyle programmes and community food programmes. In this role, the President could bring Healthy Ireland alive in every community in the land, particularly in disadvantaged areas where obesity is most firmly rooted and in promoting implementation of the National Obesity Action Plan.
In 1990, only 2% of children in the State were obese. In 2016, 30.1% of girls and 31.6% of boys in Ireland were overweight, whilst 9% of girls and 10.2% of boys were classified as obese.
In the same period, obesity rose from 8% to 26% in men, and from 13% to 23% in women. The WHO says that Ireland is on course to become the most obese country in Europe with an increase in obese men to 48% and among to 57% by 2030. They estimate that 89% of men and 85% of women would be overweight or obese if current trends continue.
Meanwhile, research by the World Obesity Federation predicts that by 2025, 241,000 schoolchildren in Ireland will be overweight or obese and as many as 9,000 will have impaired glucose intolerance; 2,000 will have type 2 diabetes; 19,000 will have high blood pressure, and 27,000 will have first stage fatty liver disease.
Already children are presenting with high blood pressure and young people with early indications of heart disease that used only to be seen in middle age. Eight percent of children who participated in the Cork Children’s Lifestyle Study were classified as having high blood pressure. Twice as many overweight/obese children had high blood pressure when compared to normal weight children. The findings of the Bogalusa Heart Study showed that three-quarters of obese children remain obese as adults and are therefore at much greater risk of an adult life dominated by chronic disease and then of premature death.
Children in disadvantaged areas
The disparity between social classes in relation to obesity is demonstrated in the Growing Up in Ireland study which shows that children from disadvantaged areas are more likely to be obese from nine years of age. In addition, 19% of boys and 18% of girls from professional households are overweight or obese, the rate soars to 29% of boys and 38% of girls from semi-skilled and unskilled households.
The cost of obesity
It’s estimated that the cost of obesity in Ireland is €1.13 billion each year. Unless action is taken it’s predicted that this could more than quadruple by 2030 to €1,175pa for every man woman and child in the State. The total lifetime costs of childhood obesity in the Republic of Ireland are estimated to be €4.6 billion, with the direct healthcare-associated costs estimated at €1.7 million. If body mass index (BMI) reduction of 5% would reduce the lifetime costs by €1.1 billion. The estimated excess lifetime cost attributable to childhood obesity and overweight is €16,036 per person.
The drivers of obesity
Childhood obesity is a complex problem with a range of causes. Society needs to take a long-term and multi faceted approach if we are to tackle the problem effectively. However, measures to tackle overweight and obesity have focused primarily on education, awareness and media campaigns spelling out what action people can take themselves. But tackling obesity isn’t just about personal responsibility. Given the dramatic rise in obesity levels, if you believe it is, you must also believe there has been a collapse in personal and parental responsibility in this generation – which demonstrably isn’t true.
There is no single, or simple, cause of the poor quality of children’s diets or of the high prevalence rate of overweight or obese children. Environments can promote health, but they can also cause ill health and obesity. The WHO defines an obesogenic environment as “an environment that promotes high energy intake and sedentary behaviour. This includes the foods that are available, affordable, accessible and promoted; physical activity opportunities; and the social norms in relation to food and physical activity.”
In short, I believe the key drivers of the obesity epidemic are:
- The ever-increasing ubiquity of unhealthy food and drinks. Junk food is more accessible than ever – temptation is everywhere at all times of day and night with greater access through more retail outlets, takeaway deliveries and more junk products with the world’s biggest food companies spending huge amounts to pack more calories into ever sweeter, saltier and energy dense foods.
- The relative cheapness of unhealthy foods. Research shows that calories from healthy foods (fruit, vegetables, lean meats, etc.) are up to ten times more expensive than from foods high in fat, sugar and salt.
- Relentless marketing of unhealthy products. The causal link between junk food marketing to children and child obesity was established more than 15 years ago. UK studies show that one off exposure to a single unhealthy food or beverage advert increases food intake by 30-50 calories. An additional 48-71 calories is all that’s required over time to generate weight gain in children. A Cancer Research UK study found that seeing one extra unhealthy food or drink advert a week results in average additional consumption of 18,000 calories a year.
- Sedentary lifestyles. Three quarters of Irish 9-16 year olds access the Internet daily. New Safefood research has shown that 10-12 year-olds spend an average of two hours a day online, rising to three hours at the weekends, whilst European research found that 15-16 year-olds spend an average of five hours online. Ninety per cent of Irish schools do not provide the minimum recommended physical activity time of two hours a week.
The critical measures to tackle child obesity could include
- Ban junk food marketing to children under 16 and other restrictions
- Make schools protected environments from provision and marketing of HFSS (including no fry zones and ban on vending machines)
- Develop SSD tax and explore new unhealthy food and beverage levies
- Subsidies for healthy foods such as fruit and veg
- Measures to counter food poverty (including expansion of School Meals Scheme and national roll out of Family Food initiatives)
- Create a healthier built environment (healthy living integrated into all planning, including more safe play areas, green spaces, walking and cycling routes)
- Priority for health promotion (more support for mothers in babies’ first 1,000 days and delivery of promised national guidelines on sedentary behaviour)
- Mandatory front of pack labelling and point of sale information
- Restrict promotions and sponsorship
- Government commitment to provide leadership and set targets
- Incentivise the food industry to provide healthier options
My own view is that there has been a lack of action in the Oireachtas on this issue. We have witnessed very little action over many years. In recent months however, some concrete measures have been put in place, such as the sugar sweetened drinks levy, the introduction of nutrition standards for the School Meals Programme and the appointment of Prof Donal O’Shea as the HSE’s clinical lead on obesity.
There is a view – of which I concur – that this is just scratching the surface of an effective response to the crisis. Replies to Parliamentary Questions indicate that last year just €2.7 million was spent on obesity prevention initiatives by the HSE’s Health and Wellbeing Division, whilst no funding has been allocated to deliver on the National Obesity Action Plan since it was published two years ago.
Healthy Ireland. A Framework for Improved Health and Wellbeing 2013-2025
Healthy Ireland provides an overarching governance structure and monitoring mechanisms to support the implementation of its strategies with a view to improving health and wellbeing for all people, at all stages of life and in all sections of society.
Goal 1: Increase the proportion of people who are healthy at all stages of life
Goal 2: Reduce health inequalities
Goal 3: Protect the public from threats to health and wellbeing
Goal 4: Create an environment where every individual and sector of society can play their part in achieving a healthy Ireland.
Better Outcomes Brighter Futures. The national policy framework for children and young people 2014-2020
“Our vision is for Ireland to be one of the best small countries in the world in which to grow up and raise a family, and where the rights of all children and young people are respected, protected and fulfilled; where their voices are heard and where they are supported to realise their maximum potential now and in the future”.
The five national outcomes that we want for all our children and young people are that they:
1. Are active and healthy, with positive physical and mental wellbeing.
2. Are achieving their full potential in all areas of learning and development.
3. Are safe and protected from harm.
4. Have economic security and opportunity.
5. Are connected, respected and contributing to their world.
A Healthy Weight for Ireland: Obesity Policy and Action Plan 2016 – 2025
The Policy has its origins in the 2005 Report of the National Taskforce on Obesity, which proposed 93 actions to address the issue of overweight and obesity in Ireland. Obesity is a key priority in Healthy Ireland – A Framework for Improved Health and Wellbeing 2013–2025, which aims to improve the health and wellbeing of the people of Ireland. The short-term (five-year) targets for overweight and obesity are:
• A sustained downward trend (averaging 0.5% per annum as measured by the HI Survey) in the level of excess weight averaged across all adults;
• A sustained downward trend (averaging 0.5% per annum as measured by COSI) in the level of excess weight in children; and
• A reduction in the gap in obesity levels between the highest and lowest socioeconomic groups by 10%, as measured by the Healthy Ireland and COSI surveys.
Get Ireland Active! National Physical Activity Plan for Ireland
This Plan, promised under Healthy Ireland Framework, was published in 2016 and aims to increase the number of people taking regular exercise by 1% a year over ten years – a total of half a million people.
Key activities include a new Physical Activity Week; support for 500 new community walking groups; extension of the Active School Flag Programme to another 500 schools; further training for healthcare professionals on using physical activity to prevent or treat chronic conditions; a campaign to get employers to encourage Healthy Workplace initiatives through walking and exercise activities, standing desks and other measures; new guidelines on sedentary behaviour, including warnings about the dangers of lengthy inactivity.
British-Irish Parliamentary Assembly Committee D Report on Childhood Obesity
“The rates of childhood obesity have increased across the developed world, not least in the BIPA jurisdictions, where the statistics on the prevalence of childhood obesity are among the worst in Europe. Among the 35 OECD countries, the UK has the ninth worst figures, and Ireland has the 12th worst figures.”
This report aims to highlight approaches to the issue across the BIPA jurisdictions, to draw attention to examples of best practice, and to promote cross-jurisdictional cooperation on an issue that has such significant implications for all of our societies.