Tackling Childhood Obesity: Discussion

I thank witnesses for appearing before the Joint Committee on Children and Youth Affairs and I welcome them to the meeting to contribute to our hearings on tackling childhood obesity. We will be holding two sessions this morning. In our first session we will have presentations from representatives of the Association of Teachers of Home Economics; CHErIsH, the school of public health in UCC; and the home economics department of St. Angela's College in Sligo. In our second session we will have representatives of the No Fry Zone 4 Kids committee; the Irish Nutrition and Dietetic Institute; and the school of education, childhood youth and sport, faculty of well-being, education and language studies of the Open University.

I welcome Ms Maria Hickey, president of the Association of Teachers of Home Economics; Ms Maria Barry, the vice president of the Association of Teachers of Home Economics; Dr. Karen Matvienko-Sikar, who is a member of the CHErIsH organisation in the school of public health in UCC; Ms Amanda McCloat, head of the home economics department at St. Angela's College in Sligo; and Dr. Elaine Mooney, lecturer in the home economics department at St. Angela's college in Sligo. They are all very welcome.

I also welcome members and viewers who might be watching proceedings on Oireachtas TV to this public session of the Joint Committee on Children and Youth Affairs. I also welcome our guests in the Public Gallery and Senator Frank Feighan for joining us this morning.

I draw the witnesses' attention to the fact that by virtue of section 17(2)(l) of the Defamation Act 2009, witnesses are protected by absolute privilege in respect of their evidence to this committee. If, however, they are directed by the committee to cease giving evidence on a particular matter and they continue to so do, they are entitled thereafter only to qualified privilege in respect of their evidence. Witnesses are directed that only evidence connected with the subject matter of these proceedings is to be given, and they are asked to respect the parliamentary practice to the effect that, where possible, they should not criticise nor make charges against any person, persons or entity by name or in such a way as to make him, her or it identifiable. Members are reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the Houses or an official either by name or in such a way as to make him or her identifiable.

I remind members and witnesses to switch off their phones or to put them into flight mode. Putting them on silent will not stop phones from interfering with our communication systems which may affect sound quality. It makes it very difficult for parliamentary reporters and people watching proceedings online to follow what we are doing. I would appreciate if members and witnesses would do that.

I advise our witnesses that any opening statements they make to the committee this morning will be published on the website of the committee after the meeting. After the witnesses' presentations there will be questions from members of the committee.

I call Ms Maria Hickey and Ms Maria Barry to make their opening statements.

Ms Maria Hickey

The Association of Teachers of Home Economics welcomes the consultation by the Committee on Children and Youth Affairs on tackling childhood obesity. We are grateful for the opportunity to present our submissions on behalf of our members who are home economics teachers. I am the president of the Association of Teachers of Home Economics and my colleague, Maria Barry, is its vice president. We represent 700 teachers and student teachers of home economics. Being faced daily in schools with the health of our young people, we are acutely aware of the challenges that exist around overweight and obesity. The fact that one in four children is obese is alarming.

This rising level of childhood and adult obesity is placing an ever-increasing burden on individuals and society. We propose that home economics, as a school subject, is ideally placed in the context of the school setting to work towards addressing this alarming health issue facing our society.

The new junior cycle home economics specification starting in schools in September 2018 has a strong focus on health and well-being and will teach young people essential life skills in a practical way. A key strand of the specification is food, health and culinary skills, which focuses on developing a healthy, sustainable attitude and positive relationship with food through practical, experiential learning. The student will apply his or her understanding of nutrition, diet and health principles to adopt a healthy lifestyle and make informed decisions that impact the health and well-being of themselves as individuals as well as within their families.

Unfortunately, this is still only an optional area of study. As a collective group of home economists, the Association of Teachers of Home Economics, ATHE strongly calls on policymakers to make home economics compulsory for all post-primary students in Ireland. This would put the food literacy of our young people at the forefront of the agenda.

Home economics is the only school subject that teaches young people how to cook and prepare food, which are essential life skills for young people. Being able to cook for oneself ensures a dependency culture does not develop whereby people rely on processed and takeaway foods. Research demonstrates that if a young person can cook, it can have a positive impact on their health, diet quality and confidence. Internationally, in countries such as Korea, Iceland, Japan and Finland, home economics is compulsory for students to junior cycle equivalent to teach young people nutrition and food skills. These countries have superior health standards and prioritise home economics as a food education intervention.

The ATHE shares the view of the Department of Health that childhood obesity and health inequalities are critical issues that must be addressed. Therefore, the ATHE recommends as vital the investment in making home economics a compulsory subject on the school curriculum for all students in their junior cycle school years. Home economics is the only school subject on the Irish school curriculum that teaches young people food literacy and culinary skills. It is critical that all citizens of Ireland have the food and culinary skills and knowledge to provide nutritionally balanced meals for themselves and their families.

I thank the members for listening on behalf of the Association of Teachers of Home Economics.

I thank Ms Hickey. Her opening statement is noted and appreciated.

Dr. Karen Matvienko-Sikar

On behalf of the Choosing Healthy Eating for Infant Health, CHErIsH, study team, I thank the Chairman and the committee for the invitation to present on the challenge of tackling childhood obesity. The CHErIsH study is a Health Research Board funded study focused on the area of infant feeding and childhood obesity prevention. I am speaking today as a postdoctoral research fellow on the CHErIsH study, which is an interdisciplinary collaboration between University College Cork, National University of Ireland Galway, and Trinity College Dublin.

The first two years of life represent a critical window for the prevention of childhood overweight and obesity. How, what, and when parents feed their child during the child's first two years influences children’s feeding behaviours, preferences and subsequent weight outcomes. Parents' feeding behaviours therefore represent important modifiable targets for childhood obesity prevention. Primary care healthcare professionals such as general practitioners and public health nurses have frequent contact with parents of young children. In Ireland, parents and young children currently have up to 24 contact points, such as routine vaccination visits, with healthcare professionals in the first two years of the child's life. As such, healthcare professionals are in a unique position to guide and influence parent feeding behaviours to prevent childhood obesity.

To date, the CHErIsH study has conducted a number of studies to inform development of an evidence-based infant feeding intervention to be delivered in primary care in Ireland. As a result of the findings of our research to date we have a number of key recommendations to inform primary care based infant feeding childhood obesity prevention strategies in Ireland. I will now outline these recommendations. In the content and foci of obesity prevention strategies, these strategies must focus on informing and training parents in accurate and developmentally appropriate responses to child hunger and satiety cues. Early child feeding supports must include and acknowledge the importance of family and friends in infant feeding. This can be done by developing family or community-based strategies and by providing information to parents about the role of family and friends in their infant feeding experience. In addition, infant feeding must be considered as a process with changes over time for children and for parents. Provision of support to parents by healthcare professionals for both positive and negative experiences, which can change over time, is important to promote healthy infant feeding and prevent childhood obesity.

With regard to delivery of infant feeding advice and strategies in Ireland, this must be done in a clear and consistent manner across healthcare professionals, using appropriate trustworthy resources. Provision of adequate resources, training and capacity for healthcare professionals to deliver infant feeding interventions and strategies is crucial. There is also a need for greater consensus and clarity regarding the role of healthcare professionals around infant feeding in primary care. The CHErIsH research team is working with key stakeholder groups, including parents and healthcare professionals, to finalise our infant feeding intervention based on these research findings and recommendations.

I thank the members for their time and the opportunity to present to the committee.

I thank Dr. Matvienko-Sikar for her presentation. I invite Ms McCloat and Dr. Mooney to make the opening statement for St. Angela's

Ms Amanda McCloat

I am here today to represent the home economics department in St. Angela's College, Sligo. I am the head of home economics and I am joined by Dr. Elaine Mooney, lecturer in home economics at the college.

St. Angela’s College, is a college of the National University of Ireland Galway and delivers the only initial teacher education programme in home economics to masters level, educating third level students to become home economics teachers. We welcome the consultation being undertaken by the committee and are most grateful for the opportunity to address the committee today.

As it is a core aspect of home economics, I will brief the members on food education and specifically the contribution of home economics as a post-primary school subject in addressing the issue of childhood obesity. We believe that prioritising the study of home economics in post-primary schools for all students is one of the most effective health promotion strategies available to combat poor dietary choices and unhealthy eating practices and consequently, assist in achieving the aims of A Healthy Weight for Ireland: Obesity Policy and Action Plan 2016-2025.

Home economics in schools is a comprehensive programme which incorporates nutritional knowledge and practical culinary and food skills, underpinned by scientific theory. It is taught within a whole of school approach. It is the only school subject which teaches young people how to cook. It develops students’ practical food and health literacy skills, empowering them with not just the nutritional knowledge but also the practical hand-on skills to integrate healthy food choices into their own daily eating habits. Research indicates that learning to cook as a young person is positively related to cooking confidence, good health and diet quality in later life. Notably, as ATHE has said, developing food, health and culinary skills is a key focus of the new junior cycle home economics specification. Due to the practical nature of home economics, students engage in a critical way with food and health issues with an emphasis on the application of practical skills, including menu planning, shopping, cooking, health and safety, portion control, reading food labels, dietary analysis, food budgeting, and food waste.

Internationally, home economics is considered a key ingredient in the development of healthy populations. In countries such as Finland, Korea, Japan and Northern Ireland, home economics is a compulsory component of the curriculum in junior cycle education. Never has there been such a fundamental need for compulsory food education through home economics for all students, and never has there been a better time to allow this to become a reality with the new junior cycle home economics specification.

While the solution to the obesity phenomenon is multifaceted, education emerges as a clear area of access. Home economics teaches young people practical and theoretical aspects of food and the basic skills of how to prepare food for themselves and their families. Consequently, students will develop confidence in choosing, preparing and cooking food. Home economics is a key ingredient in a recipe for a happy and healthy life. It is time to wake up and get cooking. I thank the committee for listening.

I thank Ms McCloat. Before I open up the discussion to members, I ask the third level educators to outline quickly the changes that are being made in the junior cycle curriculum around the practical application of the teaching of home economics. How will this propose to improve the ability of teachers to teach the subject and, it is hoped, bring a good level of retention within students? This is for the information of the committee.

Ms Maria Barry

There is an increase in the percentage weighting for the food strand, which is the culinary part of it. We have gone from 35% to 50%. It is not just about cooking. There is also the theory related to the dishes the students will cook. They will compare the dishes to takeaway varieties and shop-bought versions.

It means that when they buy ingredients they will understand the information provided on food labels.

Ms Amanda McCloat

Next September a new specification that is comprised of three strands is due to be implemented in schools. The main strand is food, health and culinary skills, which aims to develop a healthy and sustainable attitude to, and a positive relationship with, food. The strand marries together theoretical knowledge, practical application and scientific theory. It means that students will be much more engaged in the practical application and will learn how to cook food. The subject of home economics is taught as a life skill so it is very much about developing one's ability to cook food for oneself and for one's family.

That intervention has been helpful. I will now open up the discussion to members and call Deputy Mitchell first.

I thank the witnesses for their attendance. I remember studying home economics a long time ago. How many hours a week is spent on teaching home economics? What proportion of the time is spent on sewing, cooking, etc?

Are the witnesses aware of studies on the link between studying home economics and improved nutrition for individuals? Will the introduction of home economics, as a compulsory module in the junior certificate cycle, put pressure on the education system?

Ms Maria Barry

The hours for all of the subjects in the new junior cycle have been reduced. That means there are now 200 hours allocated for the teaching of home economics. The amount of time depends on the year. In terms of the current junior certificate home economics course, one might have four class periods for first year, second year and third year with a class period being 40 minutes in duration.

Dr. Elaine Mooney

On the question of research on cooking skills, there is international evidence and national evidence from the island of Ireland in respect of cooking skills and diets of better quality. Last year, St. Angela's College, Sligo, in conjunction with Queen's University Belfast, conducted an island of Ireland nationally representative sample research into cooking skills that was sponsored by safefood. The results showed that those who were taught to cook as young children and teenagers had better cooking skills and a better diet as adults than people who had not received such training. It was also revealed that they also had greater confidence when preparing home-cooked meals.

In terms of scientific evidence, the preparation of food at home is a key part of a multidisciplinary approach to tackling obesity implemented in other countries. In addition, the scientific literature refers to what is called a nutrition and culinary skills transition, where people no longer have the same level of cooking skills as in the past. Norway and Finland are two countries that exemplify best practice. Both countries have integrated the teaching of these necessary skills into the curriculum because that is when they can reach more students, and at a relevant age.

Ms Amanda McCloat

In 2017, as many as 36% of the total junior certificate population studied home economics or 22,257 people, on average, studied home economics.

In terms of pressure, the study of home economics could be introduced here on a phased basis like in Northern Ireland. That jurisdiction has made it compulsory to study home economics up to key stage 3. In the North, home economics is now taught as part of its learning for life and work programme because home economics is taught from a life skills perspective. They have also introduced topics such as healthy eating, home and family life, and independent living. Undoubtedly, there will be some challenges at the very start but these can be managed and overcome through the provision of adequate resources and facilities. Like all health promotion, prevention is key as opposed to being reactive. We need to invest in teaching young people, during their formative years, the skills of cooking, food appreciation and to encourage them to adopt a positive relationship with food, which is critical and lasts a lifetime.

A class period lasts 40 minutes. What is taught during that time? Is sewing still part of the curriculum?

Ms Maria Hickey

In terms of the new junior cycle, we hope to move towards having a double class and a single class during the week as part of the allocation of 200 hours. In most schools the double class period is used to teach practical skills in the kitchen such as cookery skills. Textile studies is still part of the curriculum. The single class period is used to teach theory. Due to having an integrated skills approach, theory forms part of the practical class period but in general, kitchen time takes place during the double periods. One would be hoping for an hour and 20 minutes as one's cooking time. The practical examination lasts an hour and a half, with half an hour set aside for preparation beforehand. In other words, for examinations students are allocated half an hour to organise themselves and an hour and half to cook. However, students are more prepared for national examinations and one has more time to set them up. The time of one hour and 20 minutes in school is good. That is the recommended time and, as home economics teachers, we would push for that amount of time.

I have some questions for the witnesses from St. Angela's College. I note they have recommended that modules on basic food preparation and cooking skills should be made available to families. How would such a scheme operate in practice?

Ms Amanda McCloat

In the Sligo region we currently offer families short-term interventions. Those projects have focused on working with families from lower socio-economic groups to try to develop their skills. We have taken a bottom-up approach insofar as we work with participants when developing the programme. This involves menu planning, budgeting, shopping for food and helping people to develop skills of discernment. We do all of this in order that they know the best choices to make and to take that into the kitchen and be able to make a healthy, budget-friendly meal with a minimum amount of ingredients.

We envisage that home economists would work with families in the community. A similar model called the extension services exists in the US and Arizona, in particular, has a very strong extension service. In that instance, home economists or family consumer scientists work with families that have been referred to them by public health specialists. When, for example, a mother leaves hospital after having a baby, she is assigned a home economist who works with her and teaches her how to prepare foods for weaning. Such basic skills, even from an encouragement perspective, are extremely beneficial. Home economists can explain to families ways to budget, how to choose the best food when shopping, time management skills, how to plan menus and, in particular, how to provide proper nutrition etc. for their young children.

Dr. Elaine Mooney

In the west of Ireland there is a small number of home economists called home management advisers who work for the HSE. The advisers have a very practical-based employment where they work with low-income families in conjunction with the Money Advice & Budgeting Service, MABS. The advisers go into people's homes and accompany the mothers or parents to shops to show them how to shop, describe what is a good buy and outline how to read food labels, etc. There is a hands-on, practical approach to the teaching of life skills. We would love to see the scheme rolled out to other health board regions. The advisers also actively engage with pregnant teen mothers and teach them infant nutrition, how to wean a baby etc. We would love to see the teaching of home economics move into the community.

Can Dr. Mooney repeat the title for the HSE staff?

Dr. Elaine Mooney

Home management advisers.

Ms Maria Hickey

From a practical point of view, many home economics teachers work as home-school liaison officers. They work with families, parents or mothers of students in schools, especially DEIS schools, to help them at home. When we teach children how to cook in class the children, in turn, can take those skills home. I often ask my pupils to bring me photographs of the meals that they have cooked. There already is a small integration of the cooking skills that have been learned in school into the home. There are home-school liaison positions available, particularly in DEIS schools. My school offers skills to the parents on different mornings where they come into the kitchen or where different things happen.

It is happening at some level, but more could be done.

I thank the witnesses for their presentations this morning. My daughter is in second year, and I had better compliment Ms Murtagh and Ms Lohan, her home economics teachers. The skill sets that children receive are the basis of education, and I welcome that the witnesses have said they would like to see home economics being made compulsory. They have asked that this be the case and when they come before committees, it is important that witnesses tell us what they think would work. That message has come from all parties today.

Ms McCloat spoke about facilities and resources, and cooking applications. Can she expand on that? What are the facilities like? What sort of resources are required? If it were to move to an all-schools approach, whereby all children in all schools were given the opportunity to acquire the life skill sets during the first three years, they would then bring those skill sets home.

Dr. Matvienko-Sikar spoke mainly, from a study point of view, about early years education. Was a study carried out on mothers who breastfeed and the obesity outcomes for their children? In terms of the 24 contact points relating to going back to GPs, we had a long discussion last week around measuring the weight of children. Does she have a view on that? Does she believe that is something that should be taken into consideration in earlier years? Many people spoke about how, by the time a child gets to secondary school, it might be too late. Should we be intervening further in primary schools in order that people know what a healthy weight is, how it is attained and the exercise that should be done?

I seek the input of the witnesses on physical education in schools. Studying home economics is one thing but does physical educational provision in schools complement it?

Ms Amanda McCloat

In terms of resources, like all facilities across the education sector, the standard varies between schools. Some schools have two or three kitchens, which would be a basic room kitted out so that there are ten work stations on average. There are generally seven to ten work stations in an individual kitchen. In an all-girls school, there are usually two functioning kitchens. Some of the mixed schools might also have two; it varies. Some male schools have kitchens. For example, I know that Summerhill College in Sligo has an excellent home economics programme and teaches home economics up to leaving certificate level. It is a very strong subject in that school. It has a fantastic new kitchen in its new build. Some of the more traditional boarding schools for boys do not have the facilities. We have found, particularly for some leaving certificate classes in the past, that those schools have joined up with an all-girls school in the area and have used the facilities there. Opportunities are available.

To kit out a school with ten stations would cost approximately €100,000. That is a ballpark figure; the cost depends on the services available and what it would take to kit out the actual room. There are approximately 700 schools, and we would have to find out how many schools actually have fully functioning kitchens. We would have to work particularly closely with the schools for boys to find out how we could strategically and incrementally kit those schools out with kitchens. According to the Department of Education and Skills criteria, kitchens are specified in the plans for all new builds of schools.

During the course of discussions in the Committee on Education and Skills the importance of making PE a compulsory subject was discussed. We were told that it would cost more than €1 billion to provide the kind of facilities necessary to make it a compulsory subject. I feel that it would link in with what the witnesses are trying to achieve. Is there a model with which we could assess the cost of equipping existing schools, as opposed to new builds, across the country? Perhaps the witnesses do not know of such a model. I imagine it would apply to our older communities, rather than those schools built in the last five years or so. It would be interesting to be able to plan the fitting out of schools with the necessary facilities, and to know what kind of figures we are talking about. If home economics was to begin in primary schools what impact would it have in terms of the Department of Education and Skills and the school patrons being able to keep pace with it?

Dr. Elaine Mooney

The Chairman has made a key point about primary schools. The evidence shows that children who receive age-appropriate nutritional education have better quality diets. We are saying that the earlier children are taught food skills, the better. We propose that modules of home economics be integrated into subjects that already exist in the curriculum, called SPHE, or social, personal and health education, in the primary school. At the moment primary school teachers teach nutrition during that subject. We have carried out island of Ireland research, funded by SCoTENS, the Standing Conference on Teacher Education, North and South, which looked at primary school teachers' experiences of teaching nutrition and food related matters on the curriculum. Overwhelmingly the teachers would say that, of all information, it is the most relevant and most worthwhile, and the students enjoy it. The teachers specifically said that to enhance teaching in that area, they need to teach practical food. They called for classroom-appropriate resources as opposed to kitchen-appropriate resources. It would not cost the enormous amount one might imagine, because the type of work the teachers would like to do would require tabletop appliances, a fridge, a hand-held blender or a microwave to enhance the experience in terms of active learning methodologies. The teachers felt that it would be really worthwhile and would not involve huge costs. Ideally, we would love to say that every primary school should be equipped with a kitchen, but that is not feasible. However, it is very feasible to equip them with tabletop appliances.

That proposal would be the early intervention that is required, before even coming to the ECCE level. To be fair to teachers in the national schools, they are already doing some of that themselves. If they cannot do it in the classroom children are brought out into the local community so that they can experience harvesting and making soups. I believe the suggestion the witness has made is very practical.

Dr. Elaine Mooney

The study referred to was an island of Ireland study, so there was a good sample size.

Has the initiative been piloted anywhere?

Dr. Elaine Mooney

It has not been piloted. Teachers were calling for resources because they feel they need help with this. They are enjoying teaching it but they need help.

Ms Maria Hickey

Home economics teachers are very frugal. If we are given money, we will make the most of it. We will not ask for any more than we need. We look at a list and only get what we want and really need. Sometimes the lists have things that we will not use, and we use the money for exactly what we need it for. We do not go over and above in our spending. We find the most economical way of getting what we need.

I asked a question about breastfeeding. Have any studies been done in terms of breastfeeding?

Dr. Karen Matvienko-Sikar

Our study team did not specifically look at outcomes of breastfeeding. There is a considerable body of national and international evidence which links breastfeeding initiation and duration with later weight outcomes. Our intervention is looking at early breastfeeding and the complementary feeding and weaning components. We have conducted a number of focus groups in Cork and Galway, with both breastfeeding and non-breastfeeding parents to ensure a mixed group of people. We have found that a number of the challenges that are faced by parents in terms of promoting healthy feeding and engaging in it with their children up to two years are the same challenges that have been highlighted by the other speakers here. There are many practical issues, such as not knowing what to feed, when to feed and how to prepare the food for children, particularly around complementary feeding.

There are also challenges around cost across socio-economic groups, so it was not just about lower income parents. We also noted this in a larger qualitative piece that looked at international evidence. We synthesised a large body of international studies and found that across socio-economic groups people reported the cost of healthy feeding was a challenge. There is also the time to prepare the food, particularly for working parents. With respect to some of the propositions and recommendations brought forward today, if we can upskill parents or put in a preventative measure whereby parents come to this key juncture with skills, it would be useful. This is the practical aspect of preparing food and knowing how and when is challenging for parents. This is when they may engage in less healthy approaches.

Did Ms Matvienko-Sikar come across the home managers and advisers and the good work I hear they do, or how that had an impact on families?

Dr. Karen Matvienko-Sikar

We had not in the population we studied. That had not come up but that could be due to the region. The parents we spoke to were positive about the supports for breastfeeding, and particularly websites such as www.breastfeeding.ie website, as well as public health nurses. They felt that once they moved from breastfeeding to complementary feeding, the support and advice was less consistent. In many cases, they did not feel it was there for them. The supports were lacking irrespective of whether people were breastfeeding or formula feeding.

There was a question about waiting times in primary care practice. It is something that we have spoken about, particularly with respect to our study site where we will pilot our intervention. It will be particularly useful. Based on the work done with healthcare professionals, particularly on strategies for obesity prevention in infants, the issue is the capacity of health care professionals to deliver any of these messages. That relates to time, resources and when this would be possible. I suppose the same issues arise in respect of weighing children at these visits. It is an additional few minutes but it is a cumulative cost to the health service. A study conducted by my colleague, Dr. Michelle Queally, using Growing Up in Ireland data, indicates that parents, particularly mothers of three-year-old and five-year-old children, tend to consistently misperceive their children's weight. When children are overweight or obese, mothers in Ireland tend not to be as good at noticing, particularly when a female child has a high birth weight or a mother is of a lower socio-economic status or is overweight. Having the weighing within the primary care setting and public health contact points is an opportunity for this early prevention strategy to be implemented. Our research evidence supports that.

What about physical education in schools?

Ms Maria Hickey

Realistically, physical education is extremely important. However, the nutritional side is the key. We look at everything that is said but it is 75% to 80% about nutrition and 20% to 25% about physical education. The home economics and physical education departments in most schools work well together. There are healthy eating or health and well-being weeks. There are many different activities. Physical education is important but from our perspective, nutrition is even more important. That is why we are calling for home economics to be a compulsory subject and be at the forefront in tackling the problem.

What about weighing in secondary schools? It was discussed last week.

Ms Maria Hickey

It could cause problems. Perhaps if it had been phased in and children had grown up with it, they might not find it so difficult. I am working in schools for almost ten years and if I told first year or sixth year students they had to be weighed, they would not be too happy. There are so many problems with mental health among young people that it is not something that will work.

I thank the Ms Hickey for her honesty.

I thank the witnesses for coming in. I have one question and it is open to any of the witnesses answer. It relates to the removal of choice and making home economics a compulsory subject. What difficulties do gender norms and stereotypes present for getting buy-in? Making it compulsory does not guarantee buy-in. There is a grain of truth in all stereotypes and while some are redundant, others are formed on the basis in the Constitution, which guarantees the woman's place in the home. I say this as a member of the lesbian, gay, bisexual and transsexual, LGBT, community who understands that heterosexual people are often the biggest recipients of homophobia in schools and that "gay" is still a term of abuse in the playground. Anything bar rigid masculinity could be identified as such. Do we face a challenge in getting buy-in from all students and are stereotypes and gender norms an obstacle?

Ms Amanda McCloat

The Senator made a good point. Current statistics indicate that of the 36% of people studying home economics, the majority are female. That is not a reflection on the subject but more down to the fact it is often scheduled in schools against what would traditionally be perceived as "male" subjects such as wood technology. If it was made available to all students, it would remove the stigma of a boy doing the subject. With the new specification coming on-stream for junior cycle in September 2018, it comes from a life skills approach and there are no inflictions that males or females should look at a particular aspect. Home economics teachers are conscious of the students in front of them and do not stereotype roles in the home. By making it compulsory, the stereotypical notion of who should be studying the subject would be removed.

Japan has had compulsory home economics for males and females since 1989. It had a traditional gendered, segregated society and it faced the same challenge of having males coming in to work with textiles, cooking, and learning about child rearing and development. They overcame the challenge with the idea that everybody had to do it because it is important for everybody's home life, no matter what type of family. It overcame the issue in 1989 and I am sure it is not insurmountable for Irish society to do so in future.

Ms Maria Barry

I worked in a school where students picked subjects before coming into first year and my classes were all girls. When I worked in a mixed school where students had a taster module, my classes were half boys and half girls. If they get exposure and see it is not all for girls, it has an effect.

I had a double module in first year and then had the choice to keep it on. It is also not lost on me that fully functioning kitchens for all-boys schools or in primary schools to start the process earlier would help.

Dr. Elaine Mooney

In some rural areas, where there may be a boys school and a girls school, there might be an arrangement for the boys school to use the facilities of the girls school to teach home economics. Such an arrangement could be looked at in the interim.

Senator Warfield has hit the nail on the head regarding the stereotyping of home economics. As Ms Barry noted, most students, including me, had a choice between a practical subject or home economics in first year at around the same time. In the 1980s, I did not have any practical reason to choose the subject so I chose something else. As the witnesses implied, being exposed to it through friends in secondary school, it is a subject I would not have minded doing. I am fortunate in that I grew up in a house where both my parents cooked, predominantly my father during the week and my mother at the weekend.

That is possibly role reversal, but that is the way my family was. I was very much involved in the cookery. There is a great deal of pressure on parents to find the time to cook a healthy meal. Many people, although not enough, do batch cooking. People get home from work at 6 p.m. to 6.15 p.m. on a weekday and the last thing they want to do is all the preparation to produce food in a meaningful way for the family or for the adults. It becomes an even bigger issue when adults and children need to be fed and one must plan ahead. One of the worst aspects of parents being extraordinarily busy is that they have to consider what the childminder, the nanny or the childcare facility where the children go feed them?

Based on my experience of the past couple of years, I have observed what it is that children are eating. Often parents do not think about it. People my think about in the car or on the train on the way home, but many people do not think about it at 4 p.m. when the minder is thinking about what she or he will feed them. An important aspect of childcare is giving children that skill set. Dr. Elaine Mooney referred to giving people confidence. One of the major issues for me a busy parent is having the confidence to go into the kitchen to prepare something healthy for all to eat or instead pick up the phone or, worse, use an app, which is tempting and dangerous, to order food.

What are the practicalities of making home economics not only a compulsory subject at second level but introducing it as a more hands-on subject at primary level? I agree that pooled resources in a primary school that can be lifted and moved into a classroom once a week or so makes sense. How much it will cost is the question that must be asked but it is our job to address that. From a practical perspective it makes sense. I camped frequently when I was a child and I know how easy it is to use a portable kitchen, but it would not necessarily be wise to bring a gas cylinder into a classroom. There are many options now and they are affordable as well, which is good. How should this be resourced? I imagine that, like most subjects, there is a shortage of home economics teachers throughout the country. How can sufficient numbers be upskilled to get to the point where we are able to introduce compulsory home economics at second level?

Ms Amanda McCloat

St. Angela's College is responsible for educating home economics teachers. We are the sole provider of home economics teacher education in the country. We will take in 112 students next September who will qualify to be a home economics teacher. In addition, we will shortly launch a professional diploma in home economics. We are cognisant of the shortage of teachers and we will upskill out of field teachers. If somebody is a registered teacher in another subject, he or she will have the opportunity in September to go to St. Angela's College for one year to qualify as a home economics teacher. He or she will be recognised by the Teaching Council in home economics in addition to whatever subjects they may have. That is a new development, but we are being proactive to respond to the shortage of home economics teachers. We also have developed a bachelor of education in home economics, which we hope to roll out shortly as well. We are being proactive and cognisant of the fact that there is a shortage of home economics teachers.

Teaching home economics is predominantly a female profession and home economic teachers avail of a number of types of family leave. While a shortage is reported frequently, but it may be for a period of specific cover, for example maternity leave, short-leave, carer's leave and so on. That is a challenge the profession faces in terms of providing teachers for those short-term periods of cover. All our graduates last year, with the exception of two, went directly into schools to schools. The two graduates who did not went on to study for a full masters programme. We are keeping a record of where our graduates go.

Ms Hickey mentioned that in 1989 home economics was made compulsory in Japan for students up to junior cycle equivalent in to teach young people nutrition and food skills. If I am not mistaken, this was also done in Northern Ireland.

Ms Amanda McCloat

Yes.

What has been learned from the experience in Northern Ireland? Can Ms McCloat envisage a process by which we could start an initiative to give it practical application? Bearing in mind the role of the joint committee, we shadow many Departments, as we have found in the past few years. This is another example of where we will cross into other Departments and make recommendations to other committees, which will then make recommendations to their line Ministers. It is important for us to propose practical applications of what we have learned in these hearings. What does Ms McCloat consider to be a practical, reasonable approach to beginning the process, perhaps extracting the best bits of the experience in Northern Ireland?

Ms Amanda McCloat

That is am interesting point. The subject is well established in Japan, as it is also compulsory in primary school for two years as well.

I mentioned some of the challenges being faced in Northern Ireland in respect of teaching resources. We have been proactive in trying to address that in the South. We are engaging in a research project with Ms Mairéad Davidson, who is my equivalent in the University of Ulster, into how they rolled out home economics to key stage three. We will investigate some of the challenges and benefits perceived by teachers perceive. We hope to have the outcome of that project in a few short months. We will happily share that with the committee.

The buildings unit in the Department of Education and Skills uses a clear specification for school kitchens. The unit may have some figures in respect of what that would cost, or what that has cost in the past to kit out various schools that it has overseen.

Do the home economics classroom layouts work?

Ms Maria Hickey

Yes, they do and they have updated the fit-out recently. There was an out of date list of equipment for a long time, with items on it that we would never use. The money spent on canteens of cutlery that we never needed could have been spent on something else. As home economics teachers, we could look at what equipment needs to go into the classroom because sometimes the list is a little off.

It is good to hear that they are on the ball. The last thing one wants to hear about is wasteful expenditure.

I wish to address a question to Dr. Matvienko-Sikar regarding to the crossover on the provision of HSE services to aid interventions for young children, in particular those who might be obese, and the solutions. Home management advisers was mentioned by Dr. Mooney, a service that I did not know existed. I thought public health nurses did this but the HSE has a team. Has Dr. Matvienko-Sikar covered that in her research on CHErIsH, and has it informed her views on the services being provided?

Dr. Karen Matvienko-Sikar

Yes, as part of the CHErIsH study, we link in with the HSE Making Every Contact Count programme. That would encompass the 24 contact points up until the age of two years and then there are additional contact points up until three years of age.

Under the Making Every Contact Count programme, the HSE is currently developing messages for healthcare professionals to deliver as well as healthcare professional training. We link in with them in order that there is crossover in the messages we are developing to be delivered in primary care. This means the messages delivered to parents are standardised. The aim of the CHErIsH project is to examine the feasibility of delivering healthy infant feeding messages through primary care and to ensure the messages are consistent with the messages that are delivered through healthcare professionals. We have crossover and links with the HSE.

With regard to the home management advisers and more practical guidance, we have feedback from many parents that we have spoken to that the more practical aspects would be particularly useful.

What is interesting from our point of view is which aspects are sustainable on a larger scale. Our focus at the moment is on trying to see what can be implemented at primary care level, while being cognisant that some of the resources parents require may be outside this. We are trying to find a balance between the two whereby, potentially, parents could be provided with signposting information to additional, more practical resources, but the initial message would be delivered in the primary care practice.

With regard to her studies, does Ms Matvienko-Sikar feel that the network of public health nurses is sufficiently resourced, and not just financially, to tackle this issue?

Dr. Karen Matvienko-Sikar

My colleague, Dr. Elaine Toomey, has led on that work, speaking with different healthcare professionals, including practice nurses, public health nurses and general practitioners. The feedback has been that capacity and resources is one of the biggest challenges for healthcare professionals to deliver preventative, proactive rather than reactive messages. The public health nurse network has been cited by the parents as being particularly useful, but there is an issue in respect of the level of trust and the relationships that exist between the parents and the healthcare professionals. That is important, both for the parents and the healthcare professionals, in terms of uptake and engagement with the messages that are being disseminated. The issue of capacity and resources is one of the main challenges cited by healthcare professionals.

This is an inter-related question for all the witnesses regarding the balance throughout the country. Is the home management adviser and outreach programme universal? Is it in place throughout the country?

Dr. Elaine Mooney

No, it is only in the west. It has been in place since the 1980s.

I wonder why it is not on our side of the-----

Dr. Elaine Mooney

It is a small number and that is something we would like to be expanded. We are looking for practitioners on the ground. In other countries, home economists are to be found only in small numbers in the school setting. They work with families in the community. The ethos of our subject is to help families with their practical problems and to give them the skills to problem solve. That is what true home economics is about. In Ireland, we have it pigeon-holed into schools and few people refer to themselves as home economists. However, we refer to ourselves as home economists because we see it as much more than just teaching in a secondary school. We would like to move it out more into the community.

Over the coming weeks the committee will engage with other people from different agencies to examine different policy interventions which have taken place in other countries such as calorie posting on menus and front-of-pack labelling. While these measures are effective, they are only effective if people are taught how to use them. Students are taught in the home economics classroom how to read a label, what is the difference between calories in and calories out, and balancing the two. We often call on the food industry to re-formulate products. Home economics students are taught in the home to do recipe modification in order that they can look at a recipe and reduce the saturated fat in that or increase the fibre and reduce the salt. Those are skills that we want every student to have in the home as well as managing their meal planning and cooking age-appropriate meals. It is important to emphasise that these policy interventions in other countries have been effective because there have been adopted in the education system at the same time.

I did home economic and I recall that we had to bring in our own ingredients, which sometimes was quite costly. Some students skipped home economics class the day we were cooking because they could not afford the ingredients. I assume that is still an issue today. How is that addressed? Does every school provide ingredients or do students still have to bring in their own ingredients?

Ms Maria Hickey

It is dependent on the school. I work in an inner city DEIS school and we provide all the ingredients. In other schools, the students bring their own. I have worked in both situations and I would prefer to provide the ingredients. It is cheaper because I buy in bulk, I buy what I need and I do not buy extra. However, it is time consuming to provide ingredients in school because it takes from the time in the classroom. Ingredients have to be weighed and measured in class whereas if the students bring them, they will have them prepared, or they will have been taught the skills to prepare them at home, and they bring them weighed. Both ways work, but it can be costly if they have not been listening to the teacher's advice. We teach them how to buy ingredients in bulk, even down to unit-costing. The bag of flour may cost €2 but to make the dish it might have only cost 30 cent. They learn that as part of the skills as well.

Are there any implications for a school's insurance if it does not have a kitchen, for example, in a national school? Would that issue have any impact or would there be a reluctance to take it on?

Dr. Elaine Mooney

I do not think so because the teachers would have identified that we would be looking for classroom-appropriate as opposed to kitchen-appropriate appliances, for instance table-top type equipment.

Dr. Mooney spoke about bringing home economics into the community. Has any work been done to liaise with Tusla? The agency set up what are known as children and young people's services committees, CYPSCs, a number of years ago. Those CYPSCs are starting to work with parents groups on nutrition and healthy eating throughout the country. Most people learn some cooking skills in the home as well as in school and prevention is better than cure. Is any work being done with Tusla and with the CYPSCs in this regard?

Dr. Elaine Mooney

At the moment there is not. St. Angela's College is very much devoted to teacher education programmes but we have a BA in home economics in the pipeline through which people will move more into careers outside home economics teaching. That is something that we are ready to run with, but resourcing is an issue.

I thank the witnesses for coming in. There was more of a culture around cooking when I was younger. It was economically driven at the time, in that it was cheaper for a household to cook than to go out and buy ingredients or buy pre-packed food. What role is the marketing of food products playing in the eating habits today according to the parents and children the witnesses have interacted with? What effect is this having? Is marketing superseding the economics of eating? Is the strong tailored packaging and marketing superseding the affordability of these products? In the past, it was a given that a person would cook but that was on affordability grounds as opposed to health grounds. People could not afford to eat out, or takeaways and fast food. What have been the witnesses' findings in this regard?

Dr. Karen Matvienko-Sikar

Our research is focussed on parents of young infants. Based on the national research we have done and international evidence, we have found that parents tend not to trust much the packaging on younger children's food products, particularly the age recommendations. Many food packages would state that they are suitable for consumption from four or six months onwards, whereas parents know they should wait until the baby is aged six months and they have been given this advice repeatedly. Whether people stick to that advice is dependent on a range of factors, but we consistently found that the parents tended to be less trusting of that type of food packaging. However, many of the constraints that we have mentioned relating to time and cost lead parents to still buy and use those products because they provide a quick and easy alternative for them. Parents tend to look through the ingredients list to identify healthy components. Returning to what the other speakers have said, however, the issue is whether they have the knowledge to interpret this information correctly. We do not know if that is always the case. The parents of young children engage in this inconsistently..

I am not sure of the position regarding adolescents..

Foods are often marketed as having a certain trigger that would be seen as healthy but the producers fail to say that there are other unhealthy ingredients in in the product as well.

Ms Maria Hickey

We do significant work on the ground on energy drinks and protein bars, which are very popular nowadays. We go through the labels with students and point out that someone could probably eat a normal chocolate bar because protein bars also contain large amounts of sugar. We teach students that energy drinks give the amount of calories or sugar per 250 ml but the can might be 500 ml. Students do not realise the can will have twice the amount of sugar. We do a lot of work with junior certificate students that involves measuring out the sugar that a soft drink will contain to try show that labelling is not always true. We teach them that what they read is not always necessarily 100% true. Hopefully, when they look to buy well packaged and well marketed products, they will at least have some knowledge and skill background in interpreting what they read.

Sometimes I nearly need an equation or formula to work out exactly what is in a product because of the way it is labelled. It may be labelled per 100 g and the product may be 20 g or it may be labelled per 20 g and the product may be 100 g. At times, someone would need to have a degree in mathematics to figure it out.

Ms Maria Hickey

We are trying to ensure children realise that when they read the label and are then able to figure it out. That is one of the literacy skills we are teaching in the home economics classroom.

Perhaps the joint committee should propose to the relevant Department that labelling or packaging do exactly what it says on the tin, so to speak, in order that customers do not have to use a mathematical formula to work out what is in a product.

It might be a matter for the Department of Health, although I am not certain.

Dr. Elaine Mooney

Legislation on nutritional labelling is in place, as are very strict guidelines for labelling. I can see Deputy Neville's point. In marketing, the issue is more about reduced fat but people may not realise that the reduced fat product could have higher levels of sugar. That is what we teach in the classroom. The food industry must follow very clear labelling guidelines with regard to ingredient declaration and nutritional composition. What we are talking about is teaching students the concept of a serving, what a serving size is and, more important, what a portion size is. This is the perspective from which we are coming.

I was horrified the first time somebody showed me - I will not mention the product - the content of a particular drink and the equivalent amount of sugar. I think I was 11 or 12 years old when somebody showed it to me. People had no idea but that has all changed now, at least for some of these products. They have all gone sugar free but I distinctly remember that. I think this falls within the area of the Department of Health.

I take on board the fact that legislation is in place but I find it difficult when I read these packages-----

I know what the Deputy is talking about.

Excuse my inadequacy in mathematics but trying to work it out is like long division when I am working off the fly.

That is a perfectly reasonable remark. I am looking at food labelling more frequently of late. I find myself saying, "hang on, the product is 400 g and this label is talking about 75 g."

To say what the 75 g is.

I then need to work that out the figure and how much of the product I will use if I am cooking or whatever. This is an issue.

Dr. Elaine Mooney

In terms of making nutritional comparisons, it is much easier to compare two products with students if they are both given the labelling information per 100 g because one is comparing like with like. In terms of an educational perspective, I understand what the Deputy is saying with regard to serving and portion sizes. It is difficult to calculate but if people want to compare products, they need two products in front of them that have the ingredients and nutritional information per 100 g.

I understand most packaging these days features a measurement of 100 g or equivalent and a recommended daily amount, RDA, which, in fairness, is helpful in trying to cross compare. This is most likely a requirement. Dr. Mooney is right, however, that the only reasonable way to do this is to have two products for comparative purposes. Is there anything else? Is Senator Warfield happy enough?

On behalf of the committee, I thank the witnesses for their presentations today and dealing with members' questions so comprehensibly. I propose that we suspend for a few minutes to allow the next group of witnesses to take their seats.

Sitting suspended at 11.05 a.m. and resumed at 11.12 a.m.

I welcome Mr. Philip Moyles, chairperson, No Fry Zone 4 Kids committee; Ms Jennifer Feighan, chief executive, Irish Nutrition and Dietetic Institute; Ms Louise Reynolds, communications manager, Irish Nutrition and Dietetic Institute; and Dr. Mimi Tatlow-Golden, lecturer, school of education, childhood youth and sport, faculty of wellbeing, education and language studies, at the Open University. I welcome members of the public who are watching proceedings on Oireachtas TV.

Before we commence, in accordance with procedure, I am required to draw witnesses' attention to the fact that by virtue of section 17(2)(l) of the Defamation Act 2009, witnesses are protected by absolute privilege in respect of their evidence to the committee. However, if they are directed by the committee to cease giving evidence on a particular matter and they continue to do so, they are entitled thereafter only to qualified privilege in respect of their evidence. Witnesses are directed that only evidence connected with the subject matter of these proceedings is to be given and they are asked to respect the parliamentary practice to the effect that, where possible, they should not criticise or make charges against any person, persons or entity by name or in such a way as to make him, her or it identifiable.

Members are reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the Houses or an official, either by name or in such a way as to make him or her identifiable.

I remind members and all our guests to switch off their mobile phones or put them on flight mode, because if they are on or muted, they will interfere with our electronic communications systems which will affect the broadcast quality and the job of parliamentary reporters, and it will affect the broadcast quality for individuals watching online as well.

I advise witnesses that any submission or opening statement submitted to the committee will be published on its website after the meeting.

I invite Mr. Philip Moyles to make his opening statement.

Mr. Philip Moyles

I am the chairperson of the No Fry Zone 4 Kids committee based in Greystones, County Wicklow. I am a dad to two girls, Amy, two, in crèche and Jess, nine, in St. Kevin's primary school, Greystones. In July 2013, a drive-through fast-food outlet applied for planning permission just 35 m away from an education campus of three schools, two primary and one post-primary, of 1,850 students. A group of concerned parents and I came together to prevent this from happening, primarily because the location was completely inappropriate and unsuitable. Over the past five years we have learned much about the planning process, the county development and how the proximity of fast-food outlets to schools can impact on childhood obesity.

Working with Wicklow county councillors over an 18 month period, a no-fry zone objective, RT 17 was adopted into the Wicklow County Development Plan 2016-2022. The important point of this objective was that it included a specific distance of 400 m where no new fast-food or takeaway outlets could be built or operated in proximity of schools or playgrounds. The distance was chosen based on the evidence gathered in studies over the past ten to 15 years, primarily in the US and Canada. These studies show conclusively that obesity rates among schoolchildren increase by at least 25% when fast-food outlets are located within 400 m of a school, particularly in lower socio-economic areas. Within that distance, schoolchildren have enough time to access these fast foods at low prices at break times. Additionally, these junk foods are promoted heavily to target schoolchildren who are impressionable and have disposable income.

Our no-fry zone proposal received significant and credible support from leading healthcare experts throughout the country through written submissions, 58 in total, during the county development plan process. These experts included the Royal College of Physicians of Ireland's policy obesity group, chaired by Professor Donal O'Shea and Professor Catherine Hayes; the Association for the Study of Obesity on the Island of Ireland, ASOI; the Irish Heart Foundation; the Irish Nutrition and Dietetic Institute, INDI; safefood; and the healthy eating active living programme in the HSE. Many academics made submissions from DCU, DIT, NUI, TCD, UCC and UCD.

There is a need for no-fry zones. No-fry zones around schools will reduce the rate of obesity by preventing easy access for schoolchildren to unhealthy foods. They will reduce the direct, constant and targeted promotion of these junk foods to schoolchildren. No-fry zones of 400 m around schools will ensure consistency in local planning when it comes to fast-food outlet applications and proximity to schools. This is very much lacking today. They will help reshape the local planning framework to reduce the obesogenic environment for our schoolchildren and in our communities. This action was proposed in the Healthy Weight for Ireland Obesity Policy and Action Plan 2016-2025.

Obesity is not a local issue but a national one. As happy as we are in Wicklow to have a no-fry zone, we believe strongly that such zones should be implemented around schools throughout the country as soon as possible. No-fry zones will contribute to the health and well-being of children and are part of the overall solution to tackle childhood obesity.

I invite Ms Jennifer Feighan and Ms Louise Reynolds of the Irish Nutrition and Dietetic Institute to make their opening statements.

Ms Jennifer Feighan

I thank the Chairman and members of the committee for the invitation to give evidence on the important subject of childhood obesity in Ireland. In our longer submission we describe the contribution made by dietitians and the evidence to support the impact of nutrition interventions. The Irish Nutrition and Dietetic Institute, INDI, is the professional organisation for regulated dietitians in Ireland. There are 900 registered dietitians in Ireland and the INDI has a membership of 760. Dietitians are the only health professionals who are qualified to give specialised clinical nutrition advice to patients. They are qualified to degree or postgraduate level and have an extended period of clinical placement in recognised training hospitals. The title of dietitian is also protected by legislation.

Good nutrition starts at home. Prevention of childhood obesity starts before the child is born and involves ensuring that a mother’s nutritional care is optimised because we know that maternal obesity has been found to be the most significant risk factor for obesity in children. Mothers need to be supported to start breastfeeding and to continue for at least six months as breastfed babies are less likely to become overweight while babies who are weaned too soon are more likely to become overweight. We also know that 80% of children who are obese between the ages of 10 and 14 will be obese adults.

We know that there is a link between childhood obesity and socio-economic position. Dietitians are trained to be able to communicate with people from all areas of society and are skilled at explaining complex issues using simple, positive and motivating language. They use these techniques to help children and their families to identify the reasons they are struggling to manage their weight. Preventing childhood obesity involves both home and school life. It encompasses supporting parents to encourage their children to be more active, eat more nutritious foods and reduce screen time. It also involves working with educators to develop a curriculum that includes healthy eating and physical activity and that promotes positive body image.

Dietitians educate families, community workers and teachers in how to promote healthy eating habits, behaviours and attitudes to food. They are also involved in very practical, peer-led cooking courses. Dietitians have a role to play as part of a multi-disciplinary team in the treatment of childhood obesity and can provide specialist nutrition support such as therapeutic diets and artificial nutrition following weight loss surgery. All of this work is done by dietitians every day and we welcome the recognition that nutrition has a key role to play in so many aspects of health. The HSE alone has over 120 strategic actions relating to nutrition across its various work streams.

We anticipate some challenges when it comes to delivering these, however, due to our low numbers. There are 450 dietitians employed by the HSE, mostly delivering specialist care in hospitals. A total of 144 dietitians work in the community. In Ireland we have one dietitian per 50,000 of population but the international guidance is 1 per 15,000. The national dietetic adviser at the HSE estimates that we need to recruit 80 dietitians per year into the community alone to deliver our national objectives. We look forward to so doing and thank the committee members for their attention.

I thank Ms Feighan and now invite Dr. Mimi Tatlow-Golden to make her opening statement.

Dr. Mimi Tatlow-Golden

I thank the Chairman. I am a lecturer in developmental psychology and childhood and a director of the centre for children and young people's wellbeing at the Open University in the UK. I was formerly based at UCD where, in collaboration with colleagues at Queen's University and Ulster University, I carried out the studies that form the basis of my written submission. Those studies were funded by safefood. I still collaborate with colleagues at UCD, with the Irish Heart Foundation and also do work on behalf of the WHO. I am here today in a personal capacity and thank the committee members for their interest in our work.

Systematic reviews have long since established that marketing exposure to unhealthy food and drinks influences children’s food preferences, requests and eating and contributes to overweight and obesity. International research shows that experimental marketing exposure increases a child's intake by 30 to 50 calories. Given that an imbalance of between 40 to 70 calories per day can tip one into being overweight over time, it does not take much marketing exposure to have an effect. Our research on the island of Ireland showed that by three years of age, children recognised over half of the food brand logos associated with unhealthy food items shown to them, and by the time they were five, they recognised almost all of them.

In 2010, the WHO recommended reductions in the marketing of unhealthy food and drinks to children and this was adopted by the World Health Assembly that same year. A child rights perspective and the upholding of children’s best interests as mandated in the UN Convention on the Rights of the Child require states to support parents in relation to children's health. All of the responsibility for children's health should not be put onto parents. They cannot be expected to make healthy choices all of the time in an environment saturated with marketing for food products that nobody should be eating except as an occasional treat. Our forthcoming WHO report on the implementation of those recommendations notes patchy progress including in Ireland.

Here in Ireland, the evidence gathered in the safefood study a number of years ago indicated that young children see upwards of 1,000 television advertisements for unhealthy foods per year. This is in a climate of regulation and regulation compliant television, but there are weaknesses and loopholes in the regulations as they stand. The new non-broadcast code is welcome in terms of establishing the principle that we should be looking beyond broadcast television, but it is voluntary, unfortunately, and it lacks defined monitoring mechanisms. We are very concerned about how it is going to play out in reality.

Something potentially radical for children's health and well-being happened here last week with the profiling amendment to the Data Protection Bill, but we will have to wait and see how that works out in practice. It is unclear how the voluntary code provisions on targeting on social media are going to play out. Other forms of marketing beyond broadcast and digital affect children’s eating, such as brand marketing and packaging, but are not regulated. I have made detailed recommendations on same in my written submission and would be delighted to discuss those further.

I thank all of our witnesses for their opening statements. The first committee member is Deputy Rabbitte.

I thank all of the witnesses for their statements. I note that they were in the Public Gallery for the earlier part of our meeting so they will have an understanding of the committee's position. I am very interested in the work done by Philip Moyles on no-fry zones, but I note that it is only in one area of the country. Has the policy been rolled out elsewhere? In terms of county development plans, would such a policy be difficult to enforce? In terms of fry zones, one is not just talking about the traditional chip shop. There are also fry zones in most service stations these days and they might get planning permission for construction quite close to schools. That is my concern. I know a lot about the good work done by Mr. Moyles through my colleague, Deputy Pat Casey. If we are serious about tackling childhood obesity, should we as legislators be seeking the enforcement of similar policies in county development plans?

Advertising to children is a pet issue for me. I believe that the broadcasting and social media codes should be reviewed. The fact that children know brands by the time they are three, even before they know their ABCs, is very worrying. The witnesses have given us a huge amount of data with which to work and many of their recommendations can be included in our final report.

Ms Feighan referred to breastfeeding in her opening statement, which I welcome because I believe it plays a huge role. The promotion of breastfeeding is an under-resourced area in the context of women's health. Ms Feighan also referred to curriculum development and I ask her to expand on that. We had a discussion with home economics teachers earlier and we also spoke about physical education, but further curriculum development is crucial. It is also important in the context of reducing screen time for children. I ask the witnesses to expand on those points.

Mr. Philip Moyles

I thank the Deputy for the question. That is our expectation. We would like to see no-fry zones implemented throughout the country, either as a result of all county councils being directed to implement them or as a result of all county councils taking it upon themselves to put it into the county development plan. We went through quite an exhaustive process working with the councillors over an 18 month period, very much providing all of the information and evidence for them to say this was a good step forward and then getting the support of all the healthcare experts, as I mentioned earlier. That is what made the councillors see this was the right step forward.

In Wicklow we started off with about six or seven councillors who supported this idea. At the end of the 18 month process, we had an overwhelming majority of 25, which is great. We have tried to engage with some other councils, but it is very much about trying to find councillors within councils who are interested in health and sharing what we have done. It is a slow process and it is quite tedious. Not every council updates its council development plan. There are a couple in every year.

In some respects, we have done the groundwork in Wicklow. We are the very first county. The first time anything is done, it sets a precedent. We went through a rigorous process in Wicklow. We spent three months looking at the wording of our objective with ex-planners. It would be much easier to show councils what we have in Wicklow and to replicate it in every other county.

I am not speaking for everybody else. Consideration of the no-fry zones must be done by the Committee on Housing, Planning and Local Government. All the heavy lifting has been done. There has to be very good work there that other county councils or the Department can take on board as a guideline.

Mr. Philip Moyles

That would be great. At the moment we are contacting councillors. I am passionate about this particular subject. It would be much easier if all councils were made aware of a very positive initiative that has the support of the entire healthcare community. The evidence is there and we have done all the work.

Our objective is concerned with what we do in future. It will not impact on existing businesses. It is about future applications. At the moment it is primarily about outlets that are selling fast food, so it does not cover garages. It is very much about fast-food outlets.

It does not concern deli counters.

Mr. Philip Moyles

No.

When I think of fast food, I think of a bucket of sausages and rashers and breaded chicken things. Some of those can be quite healthy, although not the bread so much. If they deep fry them, it is a problem, but if they bake them, it is different. One does not necessarily want to stop the local shop from stocking that sort of thing. If it is a big brand takeaway, it is an issue. It is a predominant situation now that there are fast-food outlets attached to or inside petrol stations and service stations. That might be what Deputy Rabbitte was referring to.

That is what I was coming to. It is not just the branding of the chipper. Unless everything in the deli is all salad, it will not be perfectly healthy. I am thinking about the kids on their lunch breaks having a chicken roll with other ingredients. That cannot be a healthy, balanced, nutritional lunch.

Ms Louise Reynolds

As a registered dietitian, I see children going into petrol stations and buying those rolls. Those rolls are equivalent to four slices of bread. It is not a sandwich. It is two sandwiches. I heard the home economics teachers mention portion size earlier. It is a huge issue because even if it is breaded chicken, it is not what they should be having at lunchtime. There are huge portions of meat. The amount of coleslaw that goes on top is an issue. It is very difficult to make the healthy choice in that situation. One has to be educated to make the healthy choice. I have concerns about that. This is a great first step. We need to think about the fact that food is cheaper now. Unhealthy food is cheaper. If children are going into a shop, it is harder to buy a piece of fruit, a healthier option or a small sandwich when for the same price they can get something that has probably twice the calories of an average child's school lunch.

Mr. Philip Moyles

Ideally we would prefer to have all of this encapsulated but the planning guidelines are completely lacking. There was no clarity about how close a fast-food outlet could be. This was very much a first step to say we should target the main fast-food outlets. In future, we would like to address the bigger picture.

Ms Louise Reynolds

In terms of portion size, that type of roll could be perfectly fine for a 15 year old teenage boy who is going to do an hour of rugby training after school. He will need that but one will find that the children who are not doing any sport are buying it and then going home and spending a lot of time in front of screens. They are the children who are at risk.

I do not want to focus on the delis or the service stations either. Sometimes in schools what canteens produce might not be the healthiest option either. Rolls can be available and possibly the chicken might be brought in. Portion size is an issue. We have to consider what goes on inside the four walls of schools. Do the witnesses agree with me?

Ms Jennifer Feighan

Yes. There is work going on in the HSE around the healthy eating and active living programme in terms of rolling out the food pyramid. New guidelines were developed last year. A whole load of work goes into it. One of those things is to encourage healthy vending. The other is to encourage healthy school menus to ensure the nutrition that children get in schools is optimised. A subgroup has been established to look at nutrition for children from birth to five years. As part of the healthy eating and active living programme the curriculum is being developed to give guidance to schools.

Ms Louise Reynolds

In terms of teachers promoting and teaching nutrition in primary schools, for 15 years nutrition was an elective that primary school teachers could choose in St. Patrick's College in Drumcondra. It was delivered to lots of primary school teachers every year. I taught on that module for a number of years and it was always registered dietitians who taught the module. Unfortunately, that module has been stopped this year. In recent years DCU took over St. Patrick's College and it became part of DCU. From this year that elective is no longer available, which is disappointing.

When one does a bachelor degree in teacher education in St. Patrick's teacher training college in Drumcondra, in the final year there are a number of elective subjects. There are options that students can choose from. They include things like drama in the classroom and teaching Irish as an active language. They are things where one can delve into an area of interest for the students. The title of the module was nutrition in education. Every year it was oversubscribed because students on the course are predominantly female and there is a lot of personal interest in the subject. Teachers are also consumers. They get nutritional information from Instagram and magazines. Maybe they are not getting the correct nutritional information. About 60 students attended that elective every year and it was taught by registered dietitians. When I left, two other registered dietitians taught the elective.

The elective has been cut this year. They were told that for funding reasons the nutrition elective was no longer available. That was disappointing because at least the teachers coming out of it had good evidence-based nutrition training and were going on to teach children in primary schools. That is where a lot of the learning is coming from. We do not have the required number of dietitians to go into primary schools. There are some who do community work and access schools but it is very limited.

That is invaluable information and I thank Ms Reynolds for sharing it with us. My last question related to broadcasting.

Dr. Mimi Tatlow-Golden

Was the Deputy's question specifically about how to create change in the effects of broadcasting?

I will explain where I am coming from. The submission referred to three year olds recognising the brands. They know brands better than they know ABCs at three years of age. I talk openly about the big movie television slot. We know who sponsors it and the time of the evening when it is on. We know it is targeted marketing and we also know about the gimmicks being advertised to attract the children and how this puts pressure on the parents. I believe there should be a watershed for some of that marketing and it should be after 9 p.m. I am keen to hear the viewpoint on that.

Dr. Mimi Tatlow-Golden

Several points arise. I agree absolutely with a watershed. It was really interesting when we did the research. We started with figures. We got the data through the Broadcasting Authority of Ireland on actual viewing times of young children. They were altogether different from what people had imagined. People thought young people were watching between 6 a.m. and 9 a.m. at the weekends before their parents had got up. In fact, they were watching across the day and a great deal of viewing is taking place beyond 9 p.m. A watershed is the least we would need to put in place to achieve some effects.

What we saw in the study was that people were complying with the legislation completely but it was not reducing advertisement exposure. We have seen this in other jurisdictions as well. The reason is that the advertisers move to other times. If they were advertising heavily towards children at one time, then they moved to the mixed audiences. The idea was that it would not only be during the big movie time but at the times of big sporting events. A major football tournament is coming up. If I wanted to put money on it, I would say there will be a great deal of advertising that should not really be tied in with the heroes, high-stakes physical activity and all the excitement and emotion. Psychologically, all of that gets transferred onto the brand. There is a reason they want to advertise during these events – it is not only because of the large viewing numbers.

It is certainly about identifying when children are watching television and taking the advertisements out of those times. It is sometimes considered politically unpalatable because those times are when many other people are watching television as well, including adults. However, I believe we have reached the point when we need to consider how we protect children and future generations rather than considering whether we are facilitating certain kinds of marketing activity. That is one point.

The other point relates to nutrient profiling. This is where it gets technical and it relates to the way we decide whether something should be advertised. It is a question of how we classify food and how we decide whether it is healthy or less healthy. The model we use in Ireland is derived from the UK nutrient profiling model. Studies have shown that model is very weak in terms of deciding on whether we should advertise certain products for children. In the study, we used the World Health Organization nutrient profiling model that was developed subsequently. It has been rolled out in Slovenia and other places. We found that of all the food advertisements watched by the children, half related to unhealthy food because the children were watching at times not scheduled for children's programming. However, when we classified the advertising by the WHO criteria, the figure jumped up to 75%.

Is that what you meant by loopholes?

Dr. Mimi Tatlow-Golden

Yes. There are weaknesses in the legislation. The two key weaknesses I see relate to the definition of children's programming. Really, we need to target children's viewing. It is really about what a child is seeing rather than where the advertisements are being placed. The other part relates to nutrient profiling. If we are stricter in these areas, then we take more products out. Something that came through strongly in the study was how many brands that we generally associate with unhealthier eating were leading with advertising for healthier items. This might be a fast food company advertising water, carrot sticks or milk. However, we know that when people go into those places, they have nuggets and chips. The diet is completely different. Some experimental evidence was produced by my colleague, Emma Boyland, in Liverpool. It shows what happens when children view those advertisements with the healthy items. Then, they are taken off to select things to eat. They do not select the items advertised but rather the things the brand in question is generally associated with.

It is about understanding the whole ecosystem of the marketing and not only a specific advertisement. The idea is to find where they are active in all the various areas. It extends to brand marketing. A great deal of advertising will be done using only a logo. At this point, the logo is all a company needs – the logo is enough. We have shown that at aged three years, children know what the logo is for. Before children are speaking and before they know what it is called, they can bring a picture of the unhealthy item that the logo is associated with and put the two together. As the Deputy noted, they are being reached before they know their ABCs.

Another thing strikes me from the talk today. It has been really interesting to hear about the junior certificate. We have a generational cascade that needs to be addressed. The junior certificate students are future parents. Food and food education in preschools need to be explored as well.

I have a few brief questions. I will start with Mr. Moyles. Can Mr. Moyles indicate whether the county management was on board with his idea originally?

Mr. Philip Moyles

No, they were not.

What sort of resistance was Mr. Moyles up against?

Mr. Philip Moyles

It arose during the objection phase. We had to get submissions in during the public consultation phase. After the first public consultation phase all the information is collated and shared with councillors. The chief executive officer then makes recommendations. The recommendation of the chief executive officer to the councillors was that the objectives should be removed from the county development plan. Alternatively, he recommended that if they were going to keep the objectives, then the distance should be taken out.

From our perspective, the whole idea of the no-fry zone was that we needed a distance set out. There was a reason we found ourselves in this situation with a fast food application only 35 m from schools in Greystones. The planning guidelines, although well intentioned, use terms such as "careful consideration" and "vicinity of". They are open to interpretation and that is what happened. There is a lack of consistency in planning at local level. The chief executive recommended that the objectives should come out. We countered that by providing councillors with all the information and the evidence we gathered from the studies in the USA and Scandinavia. We supported this with all the submissions from healthcare experts. The councillors could see that this was the right step forward and that putting in a no-fry zone of 400 m represented the minimum distance required for it to be effective. It was disappointing to hear the chief executive recommend that the provision come out. Luckily enough, the councillors showed leadership and took a courageous step forward. It was the first local authority in Ireland to do so. The councillors and Wicklow County Council were recognised at the Association for the Study of Obesity on the Island of Ireland conference two weeks ago for taking that step and setting the precedent.

Well done. Is Mr. Moyles aware of any other no-fry zone committees being set up throughout the country?

Mr. Philip Moyles

No. I will explain what typically happens. As I mentioned earlier, since we are now at a stage where we are getting a little publicity, people are contacting us. I was contacted by a person in Skerries last week because an application has gone in for a fast food outlet only 270 m from a school. A lady contacted me this morning to say that an application has gone in only 150 m from a school. They are looking for us to provide our experience and the knowledge we have gained through the process. That is great, but we believe we should not be in this situation.

It is very clear that if the planning guidelines were revised to ensure that no fast food outlet could be located within 400 m of a school or all of the county development plans were changed, there would be consistency in local planning. We do not have such consistency now, which is very frustrating. People do not want fast food outlets in certain locations because they might not be appropriate and they do not know what to do and they are trying to get interested parties together to fight it. That should not need to happen. The evidence is very clear that if one locates fast food outlets close to schools, one will see an increase in obesity. Children are then exposed to targeted aggressive marketing. We are in the middle of an obesity crisis and unless we start taking decisive clear action now, the problem will get worse.

Mr. Philip Moyles

Thank you, Deputy.

I hope we will see other councils make a similar move in their development plan.

I wish to address questions to the dieticians. It seems to be very common that people are weaning children on to solid foods far too early. I would like the dieticians to take the opportunity of this platform to explain the reason that children will develop.

Ms Louise Reynolds

Let us go back one step from weaning, to breastfeeding. Without doubt, the evidence shows that breast-feeding is the best option for babies. Traditionally in Ireland, we have not had a culture of breastfeeding. It is now becoming more well established. The latest figures are that 58% of mothers are breastfeeding in hospital, so they will initiate breastfeeding. That drops quite dramatically when the mum goes home. Problems can arise in the first couple of weeks and support may be needed but the supports are not there. There will be one visit from a public health nurse but there are no daily visits to help. Unless somebody has a mum, a sister or a friend who has breastfed, very often women can drop breastfeeding at that stage. We know that at three months, the number of mothers still breastfeeding are down to 36%. The target is to try to get that number up to 40% at three months. That is the first issue. We know that is the culture in Ireland compared with Scandinavian countries, where the initiation rate of breast-feeding is 98%. There is a significant distance way to go. That is something that is really important. We know that infants who are breastfed for six months or longer have a 50% less chance of being overweight or obese at the age of nine years. The evidence has shown that outcome when these children are followed. That is not only because of social class. We know that breastfeeding mothers tend to be educated to a higher level and also tend to be from a higher socio-economic group, however, we need everyone to be supported in breastfeeding. That is really important. Breastfeeding comes first and then weaning. Traditionally, I would imagine that all present were weaned at three months of age as that was what was done. One now has grandparents suggesting that such children be given something to eat because they are hungry or are crying. Following on from that, the advice was to start feeding the child at four months, but now the WHO has pushed weaning out to six months. This is due to the maturation of the baby's immune system. The baby's immune system is poorly developed when the baby is born. The reason that a baby is born at nine months is that the baby's head size can fit through the birth canal but there is a great deal of maturation that still needs to go on once the baby is born. That is why breastfeeding is the perfect food for babies. Exclusively breastfeeding up until the age of six months is now advocated and beyond that, the introduction of complementary foods.

It can get confusing because the information on some packaging of baby foods will say the product is suitable for babies from four months. The guidelines from the WHO first said that breastfed infants should be weaned at six months, but formula-fed infants were being weaned at four months. That caused a lot of confusion.

The advice now is to reduce the risk of allergy, because babies who are weaned too early tend to be at a greater risk of allergy and are at a greater risk of being overweight and of obesity because they tend to be overfed. Another issue is that breastfed babies stop feeding when they are full. One has no idea how much they have had. That may cause a bit of anxiety for the mother because she is worrying whether the baby has had enough but that allows the baby to develop his or her own sense of satiety, with the baby tuning in to when he or she is full. They are developing their own signals of feeling full. If a baby is on formula, one is anxious that the baby finishes the bottle. The baby may be full but the mum is feeling anxious because the baby has not drained the bottle. There are lots of cues and a lot more going on, which is really important.

We need to get more mums to breastfeed, but I know it is difficult. When I look back on my own experience, it was the support of friends and the knowledge that I was doing the right thing that helped me to stick with it during the first couple of weeks. After that, it can be plain sailing. It is during the first few weeks that support for breastfeeding mothers is critical. If we could get the breastfeeding rates up, it would be phenomenal for children's health and for mothers' health as well, because it protects against breast cancers and various types of ovarian cancers. There are lots of benefits to the mum from breastfeeding. I agree that breastfeeding and early weaning are critical issues.

Dieticians are trained and know the evidence base behind it. It is not based on an idea or a feeling but on scientific evidence. As for any access to dietetic support, public health nurses are trained and have some contact with dieticians in the community. The issue is to get support for mums and that is really important.

I think that is so important. I remember when I had my own daughter in 2005, there was a big drive on then to get mothers to breastfeed and there were supports in the hospitals. I wonder whether there are support groups in the maternity hospitals, such as breastfeeding clinics?

Ms Jennifer Feighan

They are there and they are very valuable. The lactation consultants are a significant resource and are very beneficial. The gap is around the appropriate weaning age. One has the support at the initial stages but six months in, when it comes time to start weaning one's baby, the knowledge gap kicks in at that point. The resources might not be there for the mother at that point. The public health nurse might not be there. The HSE has a programme, the Nurture programme, which is part-funded by Atlantic Philanthropies. I am sure members have heard of it. Part of that involves community dieticians training other healthcare staff to give evidence-based nutrition advice to support appropriate weaning and to support appropriate menu development and cookery skills for mums in the community, so that when a mother weans her baby, she is weaning him or her on to a good diet. That is really important.

Last year we put in for nine community dieticians in the Estimates, one per CHO to support these programmes. These are the kind of initiatives where €500,000 makes a major difference when it comes to implementing these programmes.

I will be brief. I wish to raise the issue of marketing and packaging of products for young children. If one has to go to a shopping centre and bring the children, it is painful because everything is bright colours and novelty shapes. Do the witnesses have recommendations on the packaging of products aimed at children? Is it achievable in an Irish context?

May I add to that question because it is appropriate to mention the sugar tax, which had a profound effect even before it was introduced, in convincing the soft drink producers, in particular, to take the sugar out of the product. I can think of some orange and cola drinks in particular. They do not sell the sugar sweetened drink in Ireland any more. They might have stock left but they are not importing or manufacturing it. It had a very significant effect, never mind the secondary effect that it is a taxation measure that raises money to invest into other areas within healthy eating programmes.

As for what Deputy Mitchell said about packaging, is there a key to doing something about it? We have done a lot in this State in terms of having been the first to introduce certain environmental measures.

Dr. Mimi Tatlow-Golden

That is it. I love to think of the smoking ban at these times. I was here when it was introduced. I am sure that everybody remembers the chat at the time, when everybody was saying that it will never happen; nobody will ever stick to it in the pubs. Then there was that phase when everybody was smoking more because they were going outdoors to smoke, because the craic was outside.

It has radically changed the socialising environments for people who work there. The sugar tax is a perfect example. Legislators need to be brave and say that there are some things that matter too much to allow things to stay as they are. A great deal of lobbying goes on and many economically threatening statements are made by certain interests warning of dire consequences. My vision is that Ireland is a food island, and we should saying that we will make some radical changes to create healthy environments where we are not exposing children and their parents to marketing techniques, which we know are effective and lead them to dangerous practices.

There are standard practices in Ireland, including the Friday night takeaway for a family. The birthday of every child in school is celebrated; if there are 30 children in a class that adds up to many birthday parties over the year. All the relatives are invited. There is a press or a bowl in each house full of chocolate bars and treats like that. That is not anybody's fault. It is nothing to do with people not having enough willpower; they are surrounded by a normative environment which tells them to do this, to be nice and loving to their children and respond to their requests. Children ask for many of these treats and that they are prompted to do so by marketing.

People will say that this is impossible to implement and that it cannot be done. However, plain paper packaging is bring introduced for cigarettes.

I was going to mention that.

Dr. Mimi Tatlow-Golden

It is clear where we are going.

Ms Tatlow-Golden said that threats were made. Ireland started the charge. We might have been the second country to introduce this but we were the first country to come up with the concept. Australia implemented it more quickly than Ireland did. The tobacco companies spent almost $500 million in their fight against plain packaging, which was a concept started by Ireland. Even more amusing, the industry has dropped the fight and is no longer pursuing it. Plain packaging is coming in shortly. It goes to show that sometimes a brave step is required.

Dr. Mimi Tatlow-Golden

Food is more complex. Smoking is easy to deal with; the advice is that people just stop. With food people can have a little bit. Who defines what a little bit is? Is it a little bit with lunch and a little bit after tea? Is it a couple of biscuits at bedtime and a treat at the weekend? That adds up to many little bits. It is difficult. Plain paper packaging on breakfast cereals would be a interesting concept to explore. One can imagine the push back there would be on that. Some changes will have to be made.

I grew up in the yellow pack era, and I do not recall crazy advertising or particular branding. It was just plain packaging. There was a lot of that in my house when I was growing up. Perhaps that was a good thing, but it is not as prevalent now. We are tackling sugar sweetened drinks, but there are also high content sugar products. We have to start looking at those, particularly confectionery - I do not want to name particular products - which includes chemically sweetened chewy bars. They are not chocolate or nougat; I do not know what they are made of. Kids are buying many such products which are clearly not good for them. By eating one every day, it is not a treat, it is normal, as has been correctly pointed out. I am as guilty as the next parent in caving at least once a day to requests for crackers, cookies or lollies. It is an issue we should start addressing in a meaningful way because it has become endemic in the first world.

A tax on high sugar content should follow the introduction of the sugar tax for sweetened drinks. I recall the outcry, when I was in my teens, about additives. The witnesses will remember when we all became aware of what E-numbers were. An additive called E123 killed people, and it was in many products. However, it disappeared quickly. We can run with our over the counter, weirdly shaped and brightly coloured confectionery, as Deputy Mitchell correctly pointed out, but I wonder where we should go on this issue because there are so many of these products. Marketing and advertising are key. That is why I was interested in what Dr. Tatlow-Golden meant by loopholes. She was not referring to a loophole, but rather a lack of direction in the standards. They are antiquated and old and they have been run through like a juggernaut by companies marketing their products. It is the job of companies to sell the product. If Ms Tatlow-Golden had a choice, what would the next step be? What measure would have a significant impact on the outcomes for children brought up in this State?

Dr. Mimi Tatlow-Golden

My vision is that children would have marketed or advertised a diet that reflects what their diet should be. The situation is inverted at the moment; the food pyramid is on its head in respect of what is advertised and so on. There will be many steps along the way to achieve that. Those steps can be picked off, one by one, or we can think about more achievable goals we can start with.

Relatively simple measures could be taken, which we recommend in the forthcoming World Health Organization, WHO, review, such as targeting what children are viewing rather than programming targeted at children. We should seek to have a nutrient profile model that restricts the foods that are advertised even more than is currently the case, even with its cheese derogation. There should be a statutory rather than voluntary code for broadcast marketing. The current code launched by the Department of Health is voluntary, and all the evidence shows that voluntary codes are not as effective. It must be well monitored and a transparent monitoring mechanism must be defined in advance. There are many parts to the code, and questions have to be asked about how they will work in practice. Brand equity characters need to be dealt with, which are the characters which are not brought in from another programme but which are associated with the product. Companies are really wedded to those for obvious reasons because they are powerful marketing tools. We need to deal with brand marketing, rather than just marketing for foods. These are difficult issues to address because companies will say that they need to reformulate and that they need space to do that. Hard questions need to be asked about them.

Information must be provided in schools and preschools. I asked the St. Angela's College representatives earlier whether marketing is part of the junior certificate curriculum, and they said that there was not really any but that there was space for teachers to insert it. It would be nice to develop, and I will talk to them about that.

Ultimately, two actions must be taken. We need to understand that choices are not made by people standing in a vacuum; they are made as a result of endless influences. We have to do away with the language of healthy choices and come up with a different phrase, because it implies that the individual, as an agentic person, whether child or parent, can make all these decisions themselves. We have to have a whole systems approach to this. The no-fry zone initiative has to be a part of it, but the entire system has to be mapped and tackled from all angles, because it affects the parents as well as the children.

That will keep us busy for a little while.

That is interesting. I wish to raise an issue for Mr. Moyles. He rightly pointed to something going on in my constituency that I learnt about this morning. It is timely that he is here. He said it took 18 months and it went on public display, I assume, as part of the current development plan in Wicklow.

Mr. Philip Moyles

It was a new proposal.

It was a new insertion and went through the statutory process, which takes a minimum of six months plus time for debate and review within the local authority. Mr. Moyles mentioned there were recommendations to remove certain aspects of what the councillors had proposed be included. Can he provide more information on that?

Mr. Philip Moyles

At the end of the first consultation phase, just before the council voted, some of the Greystones councillors we worked closely with shared the recommendations from the chief executive with us. The chief executive reviews all of the objectives and then makes recommendations. His recommendation was that the no-fry zone objective, objective RT17, should be taken out of the Wicklow county development plan. If the councillors felt strongly that it should remain in the plan, he recommended that the distance of 400 m should be taken out.

We were clear with the Greystones councillors that if the distance was taken out, the zone would be meaningless. Our perspective was based on all the evidence we had obtained through the campaign. We would have been back to where we had been with the national planning guidelines. They are well intended but the wording is vague and open to interpretation. That is how there can be situations where a council can say that it has given consideration to how close a fast food outlet is-----

"Shall" and "may".

Mr. Philip Moyles

Yes, as well as vicinity of-----

There is a lot of that in legislation.

Mr. Philip Moyles

Yes. We wanted to have a crystal clear, black and white objective at the outset in order that when it came to planning there would be a clear application for the planner to assess and no room for manoeuvre. It was either inside or it was outside.

Was a rationale provided?

Mr. Philip Moyles

No, just a recommendation. Luckily for us, and the councillors, the numbers and the quality of the submissions we had received from the experts were sufficient for the councillors to appreciate that this was a positive step forward and that we should take it. We would like this to be implemented throughout the country. We spoke earlier about obesity. It is a complex issue and there are many actions we can take. This is a relatively straightforward action, which would have a meaningful impact sooner rather than later.

This is supported by studies, and the medical and education professions. I have never been a teacher but we all know about the 3 p.m. slump and I am sure the equivalent happens in a secondary school. The only reason I can think of for the recommendation was it was a reflection of some of the submissions made but also of the commercial rates. Circumstances were probably not as rosy that year for the local authority budget as they might be now. There may have been other reasons for it that I am not aware of.

The most appropriate step I can take is to recommend the next phase of improving the outcomes for children and young adults in respect of their eating habits and learned experiences. We have not even touched on issues that the committee has discussed in recent weeks such as the provision of space for a new or recent mother to breastfeed her baby with an element of privacy. I acknowledge that does not even bother some women, which is great, because it is important that society not only accepts but embraces and supports breastfeeding as much as possible because there are so many benefits. That has been eloquently outlined. It is also important for the outcomes of the children involved. However, not everybody can do it. There is always space for a good rounded product that will support a child's growth and build his or her immunity system.

We learn about so many things - and the witnesses have highlighted this - where parents, grandparents or the older generation are influencers because they think it is right when in fact it is not. I have two children at home and I have never asked somebody to let me be the parent of my own child. I have, however, witnessed it being said by others. Perhaps education is providing people with the self-awareness to say, "Let me parent my own child, thank you very much", to people, or something similar When it comes to breastfeeding, any expectant mother watching this or anybody ever put under peer pressure not to breastfeed, should just ignore people because they do not know what they are talking about. They may have the best will in the world but they are wrong. I find that frustrating. It has come up before and Deputy Mitchell has given evidence on this before the committee.

Ms Louise Reynolds

It is necessary to see something to know it is the right thing sometimes. Like everything else, mentors are needed. A young girl having a baby may never have seen anyone breastfeed, including her sisters, not her mum nor her cousins. It would not be at the front of her mind and that is because it is not the norm yet. Breastfeeding is only being initiated by just over half of women. We need to work on that because people need to see something to think of something. Education plays a huge role. Two thirds of people in Ireland are overweight or obese. A person who has a normal weight is in the minority. Active choices have to be made to not gain weight. I refer to marketing, packaging, buy one get one free and portion size. It is easier to gain weight. A person just grazing his or her way through the day will be overweight.

We used to look to America when I was studying nutrition. We saw pictures of portions and said that is American whereas now it could be Irish. We have the same portion sizes and the same obesity and overweight rates. It is not possible to drive everywhere, sit and watch television every night, eat all these large portion sizes and not put on weight and then be a drain on the health service. Dieticians know this. We have learned all of this, it is not new to us. It is the environment we are living in now and we really need to take action. That involves planning decisions, exercising, marketing, nutrition and education. We have all said that. It is great to get an opportunity to talk to the committee because making decisions that will impact on the health of our children is important.

It is time we wrapped up and, therefore, on behalf of the committee, I thank everybody for their presentations and interaction with members.

The joint committee adjourned at 12.20 p.m. until 9.30 a.m. on Wednesday, 13 June 2018.