Joint Committee on Health and Children debate -
Thursday, 11 Oct 2012

Childhood Obesity: Discussion (Resumed)

Chairman

I remind members and delegates and those in the Visitors Gallery to ensure mobile phones are switched off for the duration of the meeting, as they interfere with the broadcasting equipment.

We are continuing our meetings on the issue of tackling childhood obesity. There were a number of meetings on the topic before the summer recess and since we have come back which will culminate in the publication of a report by the committee under the stewardship of our rapporteur, Deputy Peter Fitzpatrick. I welcome our guests and thank them for attending. We will begin with the representatives of the food and drink industry.

Before commencing proceedings, I draw 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 it to cease giving evidence on a particular matter and continue to do so, they are entitled thereafter only to qualified privilege in respect of their evidence. They are directed that only evidence connected with the subject matter of these proceedings is to be given and asked to respect the parliamentary practice to the effect that, where possible, they should not criticise or make charges against a person, persons or an entity by name or in such a way as to make him, her or it identifiable. I also advise that the opening statements submitted to the committee will be published on its website after the meeting.

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 by name or in such a way as to make him or her identifiable.

I invite Mr. Kelly, director, and Mr. Shane Dempsey, director of consumer foods, Food and Drink Industry Ireland, to make their opening remarks.

Mr. Paul Kelly

We thank the joint committee for inviting us and commend it for holding these meetings on this vital issue. We welcome the opportunity to appear before it. I am joined by my colleague, Mr. Shane Dempsey, head of consumer foods, who will make the majority of the presentation. I will make some introductory remarks on the overall position in the agrifood sector.

Agrifood is our most important indigenous industry. In total, between direct jobs, indirect jobs and linkages with the wider agricultural and rural community, approximately 230,000 people are employed in the sector, or one in eight jobs in the economy. That is the same of number of jobs as there are in the car industry in Germany. It is, therefore, our single most important industry. As we have seen in some of the announcements made in recent days, it has its highs and lows. It is under a lot of pressure in the domestic marketplace, but at the same time it is at the cutting edge of innovation in the overall food sector, not just on an Irish or European basis but on a global basis.

The profile of the food industry includees 690 enterprises, 94% of them being SMEs and 6% being large companies. Many of them have a strong export focus, but they also supply the domestic market. We sell about €9 billion worth of goods into the economy and about €9 billion into overseas economies. Food Harvest 2020, the strategy housed in the Department of Agriculture, Food and the Marine, was strongly industry-led in its development and has a vision of smart, green growth, with an ambitious export target figure of €12 billion by 2020. The industry is strongly linked with the broader economy and accounts for two thirds of exports by Irish companies. We purchase €11.5 billion worth of raw materials, other products and services in the domestic economy, while accounting for 90% of agricultural output.

There are key drivers in the industry. Competitiveness is vital, as is the brand, regardless of whether one is selling directly to the consumer or other businesses. Reputation is very important. Food safety underpins any food business operator in this or any other state. The reputational issues that flow from this are of vital importance to the food industry, as we attempt to maintain and grow our share of the domestic market and, particularly, export markets. From our perspective, it is vitally important that the image of the food industry and its reputation are not just protected but also enhanced.

Mr. Shane Dempsey

The food industry is deeply embedded in the economic and social fabric of Ireland. We are here to say we want to be an active partner in solving the problem of childhood obesity and recognise we have a responsibility in this regard. We are here to engage with the Government on the issue and commend the committee for the work it is doing to this end.

I want to take a few minutes to outline how food companies are actively living up to their responsibilities to provide the solutions that might inform the work of the committee. I respectfully ask the committee to recommend to the Government that it adopt a whole society approach that will draw in all stakeholders who have a role to play in resolving this issue. I will take members through the types of policies that would make a major difference in tackling childhood obesity. We can discuss a number of them.

Slide No. 4 sets out the food companies' contribution under a number of headings. Heading No. 1 is reformulation, in respect of which companies reduce nutrients in products; heading No. 2 is information - companies provide information and adhere to strict marketing and advertising guidelines in the promotion of their products and communications with consumers; under heading No. 3 is listed the companies that produce and market a range of products, including reduced variant products, and offer products of varying portion sizes to consumers. The final heading is active lifestyles and wellness, in respect of which companies support local community activities and, at national and EU level, support the multi-stakeholder forum such as the Nutrition and Health Foundation, NHF, and the EU platform on diet, health and physical activity.

Slide No. 5 shows the statistics from a recent survey that FDII carried out of its members. Let me highlight some of the elements. Some 82% of FDII companies have engaged in the past three years in reformulation of their products; 76% have reduced their salt content; 50% have their reduced saturated fat content; 58% have reduced their sugar content; while 60% have launched alternative products. We spoke about variants; this includes actions by companies such as the 68% which had variant portion size information on their products and the 46% which had introduced products of reduced portion size.

The issue of trans fat was raised at other committee meetings. It is important to note that the FSAI reported that trans fat levels in the population were within guidelines mainly owing to the work of food companies and FDII members in removing trans fat. The industry is taking steps to deal with the issue. I will now outline the further steps we propose to take to deal with it.

FDII members believe partnership and engagement are the way to solve obesity. Most members will agree with this. They have asked Food and Drink Industry Ireland to create a platform on which the industry and the Government can collaborate to solve the problem together. Our approach is called the Live Well Project. Slide No. 6 presents our ideas in graphical format and I will highlight some of the key points. The first pillar is that all participating members sign up to a pledge reinforcing their commitment to inform, provide choice, reformulate products and promote healthier lifestyles. The second pillar is that member companies work with the Food Safety Authority of Ireland, FSAI, on the issues of reformulation, choice and fortification on an annual basis, similar to the approach used to the salt reduction programme. The third pillar involves a national workplace wellbeing campaign aimed at creating healthier workplaces. The fourth pillar is to engage with some of Ireland's leading health professionals to identify the key research projects that will give us the necessary insights into tackling obesity. The fifth pillar lists the food categories such as cereals, bread and confectionery, on which we will work in union and consultation with the Government to agree specific initiatives where a difference can be made.

Most experts agree that obesity, childhood and adult, is a very complex problem that requires all stakeholders to work together. Slide No. 7 has a series of quotations from the UK Foresight report of 2008, the European Commission and health professionals. The message is that everyone needs to pull together. I am not under any illusion. We all have different views on how it should work, but it is important to get together and use a platform such as the Live Well Project to address the problem.

Slide No. 8 highlights the complexity of the problem, but as it is not very clear, I have a map of the 109 factors which drive obesity. These factors are interdependent and inter-related and some are more important than others. Slide No. 9 groups the factors together under the following headings: food consumption, individual psychology, the biology of the individual and food production. The point the slide makes is that obesity is a very complex problem. If one targets a single factor, the others that influence obesity are still at play. We need to get everyone involved, food companies, schools, parents, sport groups and NGOs, to address the problem.

Slide No. 10 outlines the principles of a solution. The first is a strategy for a societal response in which all stakeholders are involved. The industry want to be an effective partner in the process. Intervention should be long-term and sustained. Early and sustained interventions aimed at prevention are key to dealing with childhood obesity. Physical activity has a major role to play in dealing with it. We are willing to work with the Government on the principles of a solution to deal with the issue.

Let me outline a case study of how the partnership model will work. In 2004 the FSAI and FDII began work on salt reductions initiatives across the industry. Slide No. 11 shows some of the results of that initiative. There was a 20% reduction in the salt content of bread; a 25% reduction in the salt content of soups and sauces; a 48% reduction in the salt content of breakfast cereals since 1998 and a 19% decrease in the salt content of crisps. That demonstrates what can be done when the industry and State agencies work together to bring the population along. The last Irish Universities Nutritional Alliance, IUNA, survey found that while the level of salt consumed by people in foods had reduced, the level of discretionary salt intake had increased, in other words, people were starting to shake it on food. This highlights the complexity of the issue. One needs to supplement the efforts of the industry and the Government with information directed at particular groups.

Slide No. 12 relates to labelling and shows the guideline daily amount levels. Labelling was mentioned at the previous committee meeting. The industry introduced labels in 2009 and allocated significant resources to having them put on products. The statistics on slide No. 13 speak for themselves. Some 95% of own brand products and 83% of branded goods carry information on GDAs. This is another example of the industry working together to make a difference.

Slide No. 14 refers to food advertising and marketing. It is important to state the level of exposure of children to advertising of food products has reduced greatly. That has been a trend in recent years. In Ireland voluntary steps by the industry have led to the level of exposure of children to advertising on Irish television services dropping from 36% to 7%. This is a contentious issue which will come up in the question and answer session.

Food companies have a very high compliance rate with the existing Broadcasting Authority of Ireland and Advertising Standards Authority of Ireland advertising guidelines. They have their own internal codes as well. I mentioned the EU bodies earlier. Food companies are committed to the EU advertising pledge. A recent audit showed that there is almost 100% compliance with that across the media. A report that was compiled recently as part of the BAI consultation showed that the advertising of foods that are high in fat, sugar and salt decreased by 48% between 2003 and 2010. Under the current BAI proposals, with which everyone at this meeting is familiar, cheese will be included in the advertising ban even though one in three Irish children has an inadequate calcium intake. We believe the reason for its inclusion was the failure to lean strongly enough on data from the Irish Universities Nutrition Alliance. If we are to address childhood obesity, the point needs to be made time and again that science has to be used as part of an evidence-based approach. The world class data from the Irish Universities Nutrition Alliance, which was compiled at a cost of €7 million to the Irish taxpayer, is the best data and is the envy of other countries. It should be used when decisions on policy are being made.

The introduction of vending machines in our schools is a contentious issue that has been mentioned by the joint committee previously. I am sure we will talk about it again. I would like to say at the outset that there are no vending machines in primary schools in Ireland. In 2005, FDII and its members established guidelines for vending machines in schools. All relevant FDII members are complying with those voluntary guidelines. It is worth noting that members consult school management when they are stocking products. We have established that schools control the product mix, the introduction of vending machines and the number of machines. It is also worth mentioning, from FDII's perspective, that most schools are stocked by third party operators.

The effect that any potential increase in the rate of taxation that applies to soft drinks would have on the obesity crisis is another issue that is being examined at the moment. The evidence that taxation reduces obesity, or has any impact on obesity, is very sketchy. The reality is that taxation will more than likely affect wealth and not health. That has been the experience in Denmark. It is interesting to note that Italy has rejected any proposals for food taxation. I return to the point that all policies, regardless of their specific features, have to be balanced and have to be part of a holistic response.

FDII is respectfully asking this committee to recommend that the Government should lead a whole-of-society approach to childhood obesity. We are requesting that the committee engage with the proposal that has been made by the industry on the LiveWell project. We suggest that the committee should avoid policies that are not based on evidence and programmes that target food companies. Education and information must form the basis for policy interventions. We have cited the use of the data from the Irish Universities Nutrition Alliance in that context. I would like to finish by restating the commitment of Irish food companies to work with the Government to solve this issue.

Chairman

I thank Mr. Dempsey for this thought-provoking presentation. I also thank Mr. Kelly. I invite our guests from the Irish Heart Foundation - Mr. Chris Macey, who is the foundation's head of advocacy and Ms Maureen Mulvihill, who is its head of health promotion - to address the joint committee.

Mr. Chris Macey

I thank the Chairman for inviting the Irish Heart Foundation to today's meeting. I thank all the members who are present for the interest they have shown in this crucial issue. We believe the State is failing in its duty of care to protect the health of children. The facts bear this out. One in four children at primary school level is overweight or obese, as is one in five teenagers. Those rates are rising despite the measures being taken by the food industry, as outlined by the previous speaker. Some 23% of heart disease, which is responsible for approximately 2,000 deaths in Ireland each year, can be attributed to obesity. If legislators do not act decisively, we face an even worse future and the prospect of a generation blighted by chronic disease, long-term ill-health and premature death.

At a time when the rights of children are at the centre of the political agenda, it is extraordinary that so little is being done to protect them from the powerful environmental forces that can lead to children being overweight or obese. Political leadership is needed. Up to now, responsibility has been pushed to parents and children themselves. It seems that anti-obesity measures focus mainly on what parents and children can do to reduce risk. Media campaigns and education programmes are valuable to a point, but we need to tackle the principal driver of obesity: the ever-growing availability of cheaper, tastier and more calorific foods and beverages. Powerful and sophisticated marketing techniques that overwhelm parental will are resulting in the excessive consumption of energy-dense and nutrient-poor products. Policies which could tackle this damaging food environment, such as the prohibition of the marketing of junk food to children, the introduction of traffic light labelling and the taxing of unhealthy drinks and foods, have been slow to win political support.

I do not wish to criticise the Department of Health or the Minister, Deputy Reilly. They deserve much credit for the important work of the special action group on obesity, which I am sure the committee will hear all about in a few minutes, but they cannot tackle this complex societal issue on their own. Progress can only be achieved through a whole-of-Government approach, as Mr. Dempsey suggested. Such an approach needs to be led by the Taoiseach and the Tánaiste and should be given solid support from all Departments, including the economic Departments that often bat for the industry. Rather than having to make a choice between public health and the food industry, we are required to strike a balance between the two that puts children's needs to the fore.

Higher rates of people being overweight and obesity are inevitable consequences of the commercial approach of producers of high calorie, low nutrition foods and drinks. Their primary remit is to maximise profit for their shareholders by selling as much as they can. The commercial requirement to keep selling more and excessive consumption go hand in hand, which means that industry self-regulation cannot work. Therefore, the Government needs to make regulations that strike a reasonable balance between industry profitability and public health.

We believe there are four immediate areas of action that could bring substantial public health benefits, lead to extra revenue for the Exchequer and provide food companies with incentives to provide healthier options. We can take fiscal measures, for example, by introducing taxes and subsidies to promote health; we can protect children from marketing tactics; we can make schools healthier and more protected environments; and we can increase physical activity.

As sugar sweetened beverages have no nutritional value, taxing them cannot be regressive. It is estimated that children who consume such drinks receive approximately 20% of their recommended daily sugar intake from them. In its pre-budget submission, the Irish Heart Foundation is calling for a sugar sweetened beverage tax that would increase the price of such products by 20%. In addition to its obvious health benefits, this measure could yield approximately €60 million in extra revenue that we believe should be used to subsidise the food industry to provide healthier options for children in particular. This could also provide a win-win scenario for public health and the soft drink industry. Sugar consumption would fall and the introduction of the tax would provide an impetus for the industry to reformulate its products, avoid the tax and potentially access new markets, as well as funding subsidies for healthy produce. We are not calling for the introduction of a fat tax in our pre-budget submission. Instead, we are asking for the immediate prioritisation of a full regulatory impact assessment, including a health impact assessment, of such taxation.

My colleague, Ms Mulvihill, will go through the other measures we are advocating. As the Chairman said, she is the health promotion manager of the Irish Heart Foundation. She was also a member of the national obesity task force.

Ms Maureen Mulvihill

The second action we are proposing today is the introduction of a restriction on the marketing to children of foods that are high in fat, sugar and salt, such as snacks, fast foods, confectionery, soft drinks and sweetened cereals.

Essentially, these are most of the foods that sit on the top shelf of the food pyramid and which should only be eaten once per day. The bombardment of messages promoting foods high in fat, sugar and salt has contributed to a shift in the balance of children's diets and it is damaging their health.

The potential health consequences cannot be underestimated. A generation of children are in danger of dying younger than their parents. This is of particular concern to us because the foundation is dealing with heart disease, the number one killer. As Mr. Macey remarked, obesity is a major contributor to death from heart disease. Major comprehensive and systematic reviews have led to a statement from the World Health Organization to the effect that there is robust science and research linking commercial promotion of foods and beverages to poor diets in children. There are implications not only for obesity but for heart disease as well. Regardless of overweight, some Irish children are undernourished. They have a low intake of calcium, iron, folate and key vitamins, including vitamins A, C, and D, which are protective against cardiovascular disease.

Some 193 countries at the world health assembly adopted the World Health Organization's recommendations for members to limit children's exposure to unhealthy food marketing. This highlights that governments should take the lead on actions and monitor and measure controls. The current evidence warrants intervention at least on the balance of probabilities and on a precautionary scale. It is methodologically impossible to produce incontrovertible evidence of the effects of food advertising on children but there is vast evidence available it that warrants action.

The spend on television advertising has been reducing but it is still the greatest spend. For several years the foundation has called for a ban from 6 a.m. up to the 9 p.m. watershed of television advertising of foods high in fat, sugar and salt. We are concerned that the proposed revisions for the code of the Broadcasting Authority of Ireland, when published, will fall short of giving adequate protection from commercial advertising, thereby missing an opportunity to implement a key legislative response identified by the World Health Organization and many other international and national public health bodies. More children watch television between 6 p.m. and 9 p.m. than during children's programming hours and the case is well made in the BAI's report by the expert working group.

However, marketing on television is only the tip of the iceberg. Sponsorship of sports ranging from the Olympic Games to other sporting events and in areas where children congregate, including theme parks and recreational areas and schools, are an issue. Packaging is an issue as well. We are all familiar from walking down supermarket aisles of the vast array of products marketed to children with characters, cartoons, links to film and colourful, creative packaging. Almost all provide some incentive on the packaging, whether a giveaway or associated collectibles or more extensive giveaways that can be accessed through linking to the Internet or texting.

The Internet is a growing area of advertising. Techniques on the Internet include incentives and giveaways which are often linked to packaging. Most of the links bring children into what is termed "advergames". These are fun, creative very entertaining games but they are highly branded with many characters and colour and symbols of branding in evidence. This is an area of immediate and growing concern because it is a low cost area for the industry, it is interactive and it has considerable appeal for children and young people.

The retail sector is another area of concern because of the placement and display of products. Many products appealing to children are placed lower down on shelving rather than at a height for parents or adults. Retail outlets have purchase incentives such as "buy one, get one free" or "BOGOF" as it is termed in the industry as well as other incentives. Hallowe'en is approaching and it used to be about fruit and vegetables and nuts at the doors but now it is all about snacks and chocolate. The retail offers are for half price and reduced price goods. These areas are outside television and they are not controlled by regulation in the same way as television and broadcast media. The result is constant exposure to marketing for unhealthy foods. This normalises these products into the mainstream diet of children. Our proposed actions include a ban on television advertisements for products high in fat, sugar and salt from 6 a.m. to 9 p.m. We continue to maintain that position.

The Government and whichever is the lead agency that takes responsibility for this area should monitor marketing outside of the broadcasting sphere, especially the Internet. Parents and adults really do not know what their children are watching when they play branded games. We recognise that the Internet is global and that collaboration with other countries is necessary as part of any response. Perhaps we should consider actions in the retail area such as those announced by the Scottish Government last month. These involved the redesign of supermarkets to give less prominence to foods high in fat, sugar and salt. The authorities in Scotland have warned that if retailers and the industry do not respond then legislation will be considered.

We believe schools should be protected from all forms of marketing and commercial sponsorship. More important, they should have a health promoting environment. There is marketing in post primary schools. I accept the remarks in the presentation from Food and Drink Industry Ireland relating to primary schools. However, in post primary schools there are vending machines and tuck shops and so on. There is also sponsorship of sports, sports equipment and school events. Schools should be health promoting facilities but increasingly they are being used as marketing venues for commercial gain. The linking of foods high in fat, sugar and salt with school activities adds a strong note of endorsement and credibility to the brand or product in question.

Irish Heart Foundation research from 2007 highlighted the availability of food stuffs under discussion. Some 74% of post-primary schools provided confectionary for sale. Confectionary is the biggest form of marketing because the packaging is part of the advertising and marketing. Up to 45% of schools had drinks vending machines, 57% sold salty snacks and crisps and 52% sold sugary carbonated drinks. Our research showed that many schools have become reliant on sponsorship and funding from industry to support educational or sporting equipment. This undermines attempts by schools and the curriculum authors to promote healthy eating and healthy lifestyle. Only 30% of post primary schools had healthy eating policies and more than 90% of schools called for a code of practice for industry sponsorship and the provision and content of vending machines. Necessary actions include the code of practice to which I have referred. In addition, adequate funding should be provided by the Department of Education and Skills to ensure funding for schools for computers and physical education equipment. This point was highlighted in our research.

We recognise that the healthy eating guidelines are due to be published. We welcome this and urge that it be done as soon as possible. Schools need support to adopt a health promoting concept and this is broader than simply addressing healthy eating and vending machines. In addition to addressing healthy eating habits and the associated culture we must ensure that the school environment supports increased opportunities for physical activity as part of any health promoting school policy. The green schools initiative serves as a good example. Under funding from the Department of Transport, Tourism and Sport and the smarter travel programme, funding was provided for co-ordinators. There was huge success with the green schools intervention in respect of general health with increased activity in cycling and walking to schools. The physical activity theme is important. We call for increased support for physical activity.

Our priority suggestion is to ensure the implementation of the new physical activity plan for Ireland, which is currently in press. It should be adequately resourced and implemented. In 2010 we published a paper on building young hearts. It was about physical activity and young people in the physical environment. We carried out the project in partnership with the National Heart Alliance. Some of the members are here today, including Dr. Catherine Woods from DCU, who was one of the main authors. We urge the implementation of the 30 recommendations around the physical environment that can encourage our children to be more healthy. It includes making the areas around the school more appropriate for safe walking.

The measures we have proposed today are endorsed by the World Health Organization and other international bodies. Obesity is a complex area and we acknowledge that many other policies must be addressed but those outlined are our priorities for today. We believe they are actionable immediately at little or no cost to the State and they would make a real difference. However, we are concerned that they may not be implemented because up to now many of the initiatives proposed have been shelved or watered down due to the demands of industry. This has not favoured the health of our children and we believe that must change.

Chairman

The final group is the special action group on obesity. I welcome Dr. John Devlin, deputy chief medical officer, Dr. Nazih Eldin from the HSE, Dr. Mary Flynn from the Food Safety Authority of Ireland, and Professor Donal O'Shea who is back with us again. I invite Dr. Devlin to make his presentation.

Dr. John Devlin

On behalf of the special action group on obesity, SAGO, I thank the Chairman for allowing us to make this presentation to the joint committee on this major public health challenge to society. I am joined by Professor Donal O'Shea, Dr. Nazih Eldin from the HSE, Professor Mary Flynn from the Food Safety Authority of Ireland; Dr. Cliodhna Foley-Nolan from safefood, Dr. Catherine Woods from DCU, and Sandra Barnes from the Department of Health.

The levels of obesity and people being overweight have increased at alarming speeds in recent years, so much so that obesity has been termed a global epidemic by the World Health Organization. The problem was aggravated in recent years by our changing social, economic and physical environment, a dramatic reduction in the levels of physical activity and our changing dietary patterns. Across Europe childhood obesity is reaching epidemic proportions. It is well known that diets excessive in energy combined with physical inactivity are the key contributors to obesity. However, as acknowledged by previous speakers, the relationship between these factors - what promotes obesity - is complex. We acknowledge that problem.

There is no harm in reminding ourselves of some of the stark facts we face. Various studies have shown that children as young as three years are overweight or obese and this pattern continues as children get older. One in four seven year olds is also overweight and obese and for teenagers, the figure is one in five. This is of concern because of both the short and long-term effects, not only in childhood but also in later life. In the short term we are aware of conditions such as high blood sugar causing diabetes, high blood pressure which contributes to diabetes, and heart disease. In the longer term the effects of obesity include heart disease, stroke, type II diabetes and some cancers. These are conditions we would normally associate with people who are quite old. To compound these effects, many overweight children grow up to become obese adults. The prevalence of obesity in adults has risen steadily in Irish society, so much so that some 61% of the Irish adult population is either overweight or obese. In 1998 the corresponding figure was just 44%. This indicates a trend.

We have discussed the issue of diet. We have very good information from nutritional surveys and what these show us is that approximately 60% of infants are snacking on chocolate, biscuits and crisps between their main meals. Approximately 40% of older children and teenagers eat sweets daily and one in four drinks fizzy drinks at least once a day.

With regard to physical activity, approximately one in four adults takes no physical activity and approximately only half of children exercise four or more times a week. A particularly noticeable trend is that there is a fall-off in physical activity among older girls. For example, only 10% of girls aged 15 to 17 years had exercised during the seven days previous to being asked. The figure is a little better for boys in that one out of five had exercised.

It is well recognised by the Department and the Minister that there are a number of chronic conditions related to obesity and people being overweight and that there is also an impact on physical and mental health. The Minister established the special action group on obesity in 2011 to tackle this growing problem. Members have met some of the representatives of the group today, but we also have representatives from other Departments such as the Department of Children and Youth Affairs and the Department of Education and Skills in recognition of the multisectoral element to this challenge.

On what we can do, some years ago the OECD looked at the impact of obesity prevention strategies and concluded that the most efficient and effective interventions happened outside the health sector such as in education settings, the workplace, fiscal measures, food labelling and advertising. Where the health care system has a role and has its greatest impact on obesity and related conditions is in focusing on high risk children and adults. This is where it plays an important role. In order to take a multisectoral approach and focus on high risk individuals, our group is liaising with Departments and organisations in a cross-sectoral approach to help halt the rise in the numbers who are overweight and obese. The issues we are dealing with include calorie posting in restaurants, the impact of a levy on sugar sweetened drinks, the marketing of food and drink to children, the supply of products in vending machines, the detection and treatment of obesity, healthy eating guidelines and the promotion of physical activity. These give just a flavour of the work we do. I would like to expand briefly on one or two of these measures.

We have identified calorie posting as being an important element as a means of educating the general public on the calorie content of menus. Following public consultation and in response to the Minister having written to fast food restaurants earlier this year, the Food Safety Authority of Ireland launched a major public consultation exercise which resulted in over 3,000 responses. This has demonstrated to us that the majority of consumers and some businesses want calorie labelling. We welcome that support. There is also broad support for this type of initiative and, together with the FSAI, we are working on an implementation plan.

The issue of sugar sweetened drinks has been raised. It has been estimated that these drinks contribute approximately 5% of total daily energy in the diets of Irish children. This equates to something between 70 and 140 calories a day. On my way here today I stopped at a shop to look at some of the high energy drinks which equate to 200 or 250 calories per can. This year we established a steering group to conduct a health impact assessment of the health and economic aspects of introducing a levy on sugar sweetened drinks. In the summer the Minister launched a stakeholder day. The health impact assessment is close to completion and when completed, it will be brought to the Minister for further consideration and action.

During the summer the Minister launched the healthy eating guidelines, a copy of which I have left for committee members interested in looking at them. The guidelines are for the general population and inform people on the food and drink choices for a healthy lifestyle and set out in plain and simple language the food servings we need to maintain health and well-being. A new emphasis is being placed on food servings from the top shelf of the food pyramid and alcohol is listed for the first time as a significant contributor to calories. This is something of which many are not aware. The physical activity guidelines were launched a few years ago and we are now working on a physical activity plan. There are many good examples of local initiatives, on which we need to build. My colleagues will be happy to provide more information in the discussion that will follow our presentation.

The issue of a broader cross-government approach was raised. It is worth noting that the Department is developing a new health and well-being framework. This will set out goals for improved health and well-being which are relevant for every sector and everybody's responsibility. It will provide for new arrangements to ensure collaboration and co-operation between sectors such as children, social protection, education, housing and the environment. Many of the determinants of health lie outside the control of the health care setting such as transportation, education, workplaces and so on. Priority issues to be addressed under the framework will include implementing our tobacco policy and work on alcohol, nutrition and physical activity levels. This year we are also starting a new health and well-being survey which will allow us to measure in much more detail health and lifestyle trends across the adult population. We include in this children from as young as 15 years upwards.

The trends in obesity and people being overweight are a major source of concern. In Ireland, as in other countries, we have crossed a threshold where chronic diseases have become a challenge as great, if not greater, as those posed by communicable diseases approximately one decade ago. The rising burden of chronic disease is very much due to behavioural factors. It is due to what we eat, how we exercise, whether we smoke and high levels of alcohol consumption, all of which is amenable to prevention. The focus in the SAGO is to build on those actions previously identified, the good work done by the obesity task force a number of years ago, various health promotion strategies and the cardiovascular strategy laid out two years ago which set out clear nutrition and exercise targets. We want to move forward on all of these through our work.

A slide was presented on the complexity of obesity and the range of measures involved. The question raised was whether we were singling out a particular measure over another. The answer is no. We believe no single measure will reverse the trend in people being overweight and obese and that a combination of measures will make a difference in dealing with this challenging public health issue.

Chairman

Thank you, Dr. Devlin, for your sobering and challenging presentation. I also welcome Dr. Catherine Woods, Dr. Cliodhna Foley-Nolan and Ms Emma Jane Morrissey, who are in the Visitors' Gallery.

Deputy Michael Colreavy

Go raibh maith agat. I thank the delegation for their very informative and thought-provoking presentations. I wish to apologise ---

Chairman

I beg your pardon, Deputy. I have received apologies from Deputies Maloney, Ó Caoláin and Senator Henry.

Deputy Michael Colreavy

Deputy Ó Caoláin is taking Leader's Questions this morning and asked me to deputise for him. I must also apologise in advance on my own behalf because I will have to leave this meeting at 10.50 a.m. I will try to be brief as I note from the minutes of the last meeting that the Chairman was encouraging brevity.

I am surprised at the level of unanimity between the three presentations, although it is heartening and a good thing because a partnership approach is needed. We should be trying to design something that makes it easy for people to do the right thing and difficult for them to do the wrong thing. It is some time since we discussed the role of pricing for unhealthy food and drink versus pricing for the healthy alternatives. The food and drink industry spokesperson did not encourage that approach and has argued that it is a wealth measure and not a health measure and has pointed out that much work is being done by food production companies. The problem is, as the evidence from others proves, that what is happening at present is not working. We are not succeeding so we must examine what we are doing at present. We need to do more and we need to make sure we are doing the right thing.

I was surprised at the statement from the Irish Heart Foundation that it wants to study the proposal for taxing high-fat, high-salt and high-sugar foods and subsidising more healthy foods because I would have thought that it has been fairly well studied already. I also would have thought that there is a fair amount of political support for such a measure. Perhaps I misunderstood what the foundation was suggesting and if so, I ask for clarification.

There was no reference in the presentations to children playing computer games. It is my experience, and that of many other parents, that it is easy enough to get children away from television but once they are hooked on computer games, it can be extremely difficult to get them outdoors.

Chairman

I thank the Deputy for his brevity. He only spoke for three minutes, which is excellent.

Senator Jillian van Turnhout

I thank the witnesses for their presentations. We have had many deliberations already about the need for a multi-faceted approach to this problem. Part of me worries that we are over-analysing and over-complicating the problem. I never thought I would refer to Ms Ann Widdicombe in this context, but she said that she would love to write a book on obesity and losing weight but the only problem was that the book would only have four words - exercise more, eat less. While it is very important that we analyse the issues involved, we must remember the fundamentals underpinning this.

While I welcome much of the presentation from the food and drink industry and its positivity, I found it very difficult to see the tangible actions that the industry proposes to deal with the problem. Reference was made to active engagement, partnership and so forth and we all agree that working together is important. I would like to hear a little more on what the industry proposes we should do, apart from labelling.

Given my background, I am particularly concerned about advertising and marketing to children. Reference was made to a voluntary reduction in such advertising and I would like to know where that figure came from. Who conducted the research? We all know that with voluntary codes the good companies sign up while those at whom the codes are aimed do not, with the result that we do not solve the problem. Unfortunately, to get things done, we all need deadlines and we all need to feel someone is looking over our shoulder. I fully support the advertising ban and believe the Irish Heart Foundation is being quite moderate in asking for the ban to be in place from 6 a.m. to 9 p.m. I would go further.

The argument about cheese is being used as a red herring in the debate. It is all about moderation. Certainly there are some wonderful Irish cheeses on the market but the issue is about cheese products directly aimed at children. Such products are highly processed and include squeezy and stringy cheeses. Where is the nutritional value in such products? We need to be a little careful with some of the red herrings in the argument. Of course a balanced diet is essential but we must look at the specific products that are causing concern. I am interested in the view of the Irish Heart Foundation on the question of cheese because it is constantly raised in debates with this committee.

I note that in the foundation's presentation it is argued that only 20% of children consume the recommended amounts of fruit and vegetables. The special action group on obesity reminded us of data from the Growing Up In Ireland Survey from 2011 which found that one in four children, as young as three, are overweight or obese. That is a startling fact. We must demystify this whole discussion and get down to the basics. We can have an ongoing debate the issue of obesity but the fact that this generation of children will have a shorter life span than their parents means that we, as decision makers and legislators, must act.

Including a calorie count on menus is an excellent idea and can inform one's choices and influence one's eating decisions. However, I was surprised when I was in New York during the summer to discover that a restaurant must have 15 branches before it is required to list calories on its menus. We are often told that New York is doing it and so should we but there is a cost to restaurants. How does the delegation suggest we tackle that?

Deputy Peter Fitzpatrick

I thank the witnesses for coming here today. When I was canvassing during the general election campaign 19 months ago I could not help but notice the number of people who were overweight or obese. I said to myself at the time that if I could do something to help such people, I would. The problem is alarming.

I congratulate the Minister for setting up the special action group and some of the solutions put forward are excellent. However, since I have entered politics I have heard a lot of talking but have seen very little action. We could talk about this morning, noon and night. I can go into the Chamber and listen, for four or five hours, to all the solutions in the world but there is no action. There are a lot of clever individuals here today and we should all try to work together. I am just an ordinary Joe Soap but I am willing to help. I attended the local Novena this morning in Dundalk and the priest said that while Ireland may not have any money, 60% of our population is involved in voluntary work, which is wonderful. Let us all work together on this.

People do not understand how bad obesity is. Many people come to my clinic looking for help. I would be keen to give them help, but those best placed to provide help are across the table from me now. They are the experts. This is the first time I have seen the healthy eating and active living brochure. There is a referendum coming up and we will be sending information about it to every household in the country. This is more important than any referendum. We are investing money. Reference was made to taxes and so on but why not send one of these leaflets to every household in Ireland? Let us make a start somewhere. The only thing I ask for today is instead of talking, let us take some action.

Dr. John Devlin

I thank the committee for their helpful comments. A comment was made about the cosy relationship. It is fair to say we have our differences with the industry with regard to advertising and how it should be marketed and we make our own submissions in that respect. That process is still under way so we cannot determine what the outcome will be. That is being done through the Broadcasting Authority of Ireland. We are holding strong on the watershed and especially with regard to those foods high or on the top shelf of the food pyramid. We believe there should be restrictions for these. The booklet outlines that certain foods, especially those on the top shelf, have no nutritional value. Unfortunately, this is where most of the advertising takes place. We would prefer to see more advertising in respect of fruit and vegetables and so on. Many of the products advertised are not consistent with our healthy eating policy. We work closely with the industry with regard to potential solutions in this area. We have differences with regard to the desirability or otherwise of a sugar and sweetened drinks levy. It is fair to say there are different perspectives on that. This is why we have conducted a thorough health impact assessment and we will be reporting soon to the Minister with all the impacts relating to health and the burden of disease and obesity as well as the other potential impacts relating to trade and employment and so on. At the end of the process, we will have a good indication of the options and information to be provided to the Government relating to decisions which we believe will ensure better public policy.

A comment was made about disseminating booklets leaflets and information. I will hand over to my colleagues because, as part of our communications strategy, these booklets have been disseminated widely. We can provide a flavour of the numbers and the outlets where they have been distributed. I call on my colleague, Dr. Mary Flynn, to comment on calorie posting. As suggested, it is an important initiative but there are technical and practical considerations. We are working on an implementation plan. I will pass to my to colleagues in the front row.

Dr. Mary Flynn

I thank the Chairman and members of the committee and I thank Deputy Fitzpatrick for his comments on our leaflet. I reassure him that this leaflet has gone out from the Food Safety Authority of Ireland to all general practitioners, dieticians and all practice nurses. It is a guide for health professionals. Unfortunately, when the people read the information in the booklets and then try to buy food, problems arise. Often there are problems with portion sizes. In most cases one muffin would do for a family of five and it should be divided up in that way. This is where calorie posting comes in. We know what occurred in the United States: Kentucky Fried Chicken introduced grilled chicken for the first time on the back of calorie posting. We know that outlets selling cakes and biscuits have begun to reduce or introduce portion sizes with which we were all familiar in the 1970s. However, when we show them to people, they think we are referring to portions for children. They think a certain bottle of Coke is a dinky. We are used to portion sizes that have doubled and trebled. This has been highlighted in the booklet.

At the moment, because of the recession, food service outlets are hanging on by their fingernails. We know this is a reality. People running restaurants are not taking salaries and unemployment is affecting people severely in this area as well as in the construction area. How do we do it? Legislation was introduced in New York and consideration is being given to rolling out the legislation throughout the USA. They have suggested that the proposal of making calorie posting mandatory should apply to outlets with 20 or more branches and it would be cost-effective to do so. If one goes to the trouble of analysing recipes and standardising portion sizes, one could spread it among 20 outlets, and that is a good idea. At the moment in Ireland this is done on a voluntary basis. I thank the Minister for Health for highlighting the problem. There were outlets operating here which had posted calories in their outlets in other jurisdictions but were not doing so here. As a result of the intervention, we have had a change overnight, and that is welcome.

I am a dietician but I did not know that there were 1,200 calories in a big box of popcorn that one might buy at the cinema. Such a box contains the equivalent of seven bags of popcorn. Something strange happens to humans. When we are given such food in a box, we eat it and then we go home and decide that we only had popcorn and that we will still eat a dinner. However, somehow if we open bags of popcorn and begin to eat them, we stop after three bags and we would probably decide that we did not need dinner. We need these stops.

The most wonderful thing about calorie posting was the reaction from the population to the whole initiative. From a total of more than 3,000 consumers, some 96% responded. The Food Safety Authority of Ireland was overwhelmed by the reaction to the public consultation. It was the biggest reaction we ever had. I could not believe it but 96% of consumers suggested putting calories on everything in all outlets because they wanted to know. That was the first time we saw such a reaction. It was not from the top down or from the authority trying to do certain things but from the bottom up and it involved people who are overweight.

No one wants to be overweight and they all want a solution. I have worked in Canada, the Middle East, Britain and for most of my life in Ireland, and I have never met anyone who wants to be overweight. Everyone wants a solution. Deputy Colreavy is absolutely right about the need to make the healthy option the easy option. We need a partnership with the food and drink organisations. I have never met anyone in the food and drink organisations who has wanted to make anyone obese. They want to make a fast buck and a profit. It is about setting up a framework such that we all get to where we want to be.

Chairman

Deputy Fitzpatrick made a comment about a possible solution. I cannot disagree with any of the comments, which were brilliant. However, we held a similar discussion here last week. Let us suppose I am in the supermarket and I have my shopping list. How do I relate it to the top shelf and the pyramid? How do we get the mindset of the mother or the father or the person doing the shopping to change from the top shelf? We have no solution. Should signs be put up in the local fast food restaurant or take away? Should they put up the number of calories in fried chicken and batter burgers and so on? Does that change minds?

Dr. Mary Flynn

The research has shown that such a move would have an immediate reaction for 15% of consumers, but for the remainder it will not. However, for the first time this will affect the others because the industry would be allowed to produce portion sizes that are smaller without being called greedy and without a consumer wondering why she is not getting a massive portion although she has paid good money. That has been the problem. With calorie posting one can create demand for the healthier option around something other than price.

There are many ways it can have these effects. The problem is the cost. The Food Safety Authority of Ireland is trying to come up with a solution involving an easy-to-use computer programme and establishing a related training programme that restaurateurs could use. The plan is to embed it in the colleges which are training catering students. That is a long-term plan but it is the only way to do it. The larger operations can do it now and they should do it immediately.

RTE carried out a vox pop on the back of this and some people were asked how many calories they needed in a day. Some grown men thought they only needed 50 calories. We need to raise awareness and the only way we can do so is through such initiatives and by showing innovation. We need to catch something that hooks the imagination and follow it through. We should not blame the small restaurant owners who are hanging on by their fingernails for not putting calories on menus. We need to find solutions that will help them, and that is what we are working towards.

Dr. Nazih Eldin

With regard to distribution, it is available throughout the country through the Health Promotion Unit and the health promotion services. We can distribute it, not only to professionals in the health services but also to schools and other organisations.

I am not a politician, but may I comment? Knowledge is important and powerful, but it is not sufficient. We have to change behaviour as well. Chairman, you asked what else can one do. Scotland is proposing to legislate for supermarket displays so that the top shelves, where people can see things easily, will be changed. There are aspects of work that Deputies and Senators can do.

Health promotion in schools is a wholesome concept that needs more than the support of the Department of Education and Skills and of school management. We also need health promotion in advertising, in the availability of food in schools and so on. Health promotion in schools is one of the most important elements of all.

Breastfeeding is rarely mentioned. The levels of breastfeeding in this country are disgracefully low. Women and families need support in this regard. Great work is being done by some elements. Women need support, not only when they are in hospital but also outside hospital and even in preparation before they become pregnant.

Chairman

How can we give that support?

Dr. Nazih Eldin

One of the best programmes in the country is called the Baby Friendly Hospital Initiative. It is in place in hospitals but also in other facilities. We allow women to express milk and preserve it. We give them breaks. We invite crèches to be aligned with the health service to help breastfeeding mothers. Industry could do similar things. It could be done easily, whether in a bank or a factory.

We talked about food, and rightly so because it is part of the problem. The food industry is part of the problem but also part of the solution. We look to them to help. One solution is to have a physical activity plan for Ireland. This plan brings together five Departments, academics, practitioners and help from all over the place. The Minister of State at the Department of Transport, Tourism and Sport, Deputy Michael Ring, and Senator Eamonn Coghlan are supporting it. We hope to have it on the table in the near future and that the Government health committee will agree it. The plan needs huge support. We congratulate the Department of Transport, Tourism and Sport on its consultation document on opening facilities and sharing them with everyone. This is the response of the physical activity plan.

Mr. Paul Kelly

Deputy Colreavy spoke about pricing and taxation. It is worth noting the complexities associated with the construction and transmission of price and the whole area of margin in the food chain. This has been evidenced in recent days by 20,000 farmers protesting outside the gates of Leinster House on Tuesday last and by some of the job losses in the last day or so. There are significant issues relating to the asymmetrical transmission of price along the supply chain, that is, the ability of different players in the chain to recover costs. Much of that has to do with increased volatility in commodity prices. That, in large part, has to do with the disappearance of the managed market scenario we have had in the EU for the last number of decades. Agriculture prices and food prices are normalising towards global levels and this is introducing a significant amount of additional volatility.

It is also worth noting that the commodity that has jumped the most in the last year or two is sugar, which has gone from €400 per tonne to €1,200 or €1,250 per tonne on the spot market. From a production planning perspective, it would be incorrect to consider sugar a cheap nutrient in terms of price or availability and security of supply.

Food companies are not completely obsessed with profit. In this country, the net profit margins of the consumer foods arms of publicly quoted companies are in low single figures. At primary level, primary dairy processors and meat processors are probably working between 1% and 2% profit margins. That is the reality.

The final price is set by the retailer. Resale price maintenance is banned under competition law. Food companies and food suppliers have no part to play in the price the consumer ultimately pays. We already have a tax differential. The 23% standard rate of VAT applies to a small number of food products. They are, typically, the ones in question, including confectionery, soft drinks and cakes. There is already a 23% differential between them and all other food products, which are zero rated.

In the consumer price index, food and non-alcoholic beverages now account for approximately 11% of consumer spend, compared with roughly 25% in the 1980s. This has had a huge impact along the food supply chain. Food is a highly regulated sector, and correctly so, with regard to food safety and so on. All of these costs have had to be absorbed at production and processing level. These costs are highly relevant to this overall discussion.

In Denmark, where a saturated fat tax was introduced approximately one year ago, there is now cross-party support for the removal of the tax because of its impact on a number of areas, particularly the economic area. It has driven cross-border shopping into Germany. We had a similar issue here two or three years ago with Northern Ireland. Work done by the Central Statistics Office and the Department of Finance suggested a cost in the region of €800 million from that. Denmark has also withdrawn proposals for the introduction of an additional sugar tax. Similarly, in Italy a range of taxation measures are being examined as part of that country's austerity programme but the Italian Government has pulled back from introducing a tax of that sort.

Senator van Turnhout mentioned stringy cheese and the fact it is highly processed. The stringy cheese in question is cheddar cheese. It is no more and no less.

Senator Jillian van Turnhout

Some products are highly processed.

Mr. Paul Kelly

It is worth noting that cheddar cheese is specifically regulated for. There is European legislation that outlines the specification for cheddar cheese. The only difference is that stringy cheese goes through an extrusion process. In short, the cheese goes through a metal pipe where there is an application of heat and pressure to give it the physical characteristics with which we are all familiar.

Mr. Shane Dempsey

Senator van Turnhout asked what we can do and are doing in a tangible sense. Behind the reformulation statistics I quoted are millions of euro over the course of four or five years. For example, over five years confectionery companies removed 35 tonnes of saturated fat from the Irish diet. That took five years of research and more than 40,000 man hours. Each of us on this side of the room is actively making contributions but our contributions are fragmented. Even within the food industry each company is pursuing a different way to make a contribution. That is why we talk about a whole-of-society approach. To do the right thing, all the players must make a contribution.

There is probably a case to be made for more co-ordination. In my view, the tangible results of this action would be if it forced us to knock our heads together and, in conjunction with political leaders, come up with the strategy - the whole-society response. The quicker we do that, the better. The longer we leave it, the greater will be the future impact. The Senator also said the good companies, so to speak, will sign up.

Senator Jillian van Turnhout

It is voluntary.

Mr. Shane Dempsey

The larger companies will sign up. We need them to do that and when they do so, we need to reward them so that it incentivises the other companies to become involved. The big companies who sign up to voluntary codes are often the ones that are targeted the most by different stakeholders and groups. It means that the people who have not made the effort to be part of the voluntary code ask why they should participate in it. We need to encourage all companies to get involved and that can be done by means of a whole-society response.

My colleague has spoken about the cheese argument. This is always being raised because it is an example of the BAI's approach, which was to take a nutrient profile model from the English situation and to transpose it onto the Irish situation. There are other products, apart from cheese, that will also be restricted in their advertising and which, in our view, should not be restricted. However, the cheese advertising is being raised because this is a very political issue in Ireland. As I said earlier, one in three children have calcium deficiency. If we had used the Irish Universities Nutrition Alliance, IUNA, data, we would have identified that issue and we would have been able to use Irish data to change the system to suit the Irish population.

On the issue of soft drinks, Senator Crown put it very well at last week's meeting that no product is bad in moderation and no product is safe in excess. Despite the comments made about soft drinks, IUNA shows they only contribute approximately 2% of energy for Irish children and 60% of the population does not consume soft drinks. We are considering the introduction of a national tax across the whole population when 60% of the people do not even consume soft drinks. I ask what impact this measure will have on obesity in the medium or long term. I use this example to highlight a point that we need to target our interventions. The Live Well project has been the subject of much discussion between the industry and other groups. We think that project will be a very tangible step forward in how industry and government can work together on this issue. It would not be the place of the industry to decide on the programme for the children because by doing so, the programme would be discredited. We want to work with the relevant agencies on deciding what is the correct intervention.

In reply to Professor Flynn's statement, the food pyramid and physical activity plan are in place and the healthy eating guidelines will be in place soon. Those documents are the basis for a societal response but, as Deputy Fitzpatrick said, they might not get out there. We need to work on the implementation plan as much as possible and the industry is prepared to support it so that it is accepted by consumers and citizens.

Dr. Donal O'Shea

I wish to make a couple of points. In reply to Deputy Colreavy's question, the pricing measures for obesity are not about income generation but rather about behavioural change. There is talk about stealth tax. I understand that the income to be raised from any such taxes would be modest. We must look to behavioural change which is how patterns of consumption are changed. I acknowledge the argument that these measures are economically regressive and will affect poorer people more. In terms of health, I would consider these measures to be progressive. I refer to the concept that only 2% of energy comes from sugar-sweetened drinks. This figure is 20% for those who consume those drinks. A small number may consume these drinks but 20% of their energy intake comes from those drinks. Therefore, the tax only affects those who consume and it will hit them more. They are also in the lower socio-economic group so it is financially regressive in that sense, but their health gain is magnified, so it is progressive in health terms. The committee members are the legislators and they must decide. It is about behavioural change and progress in health terms. We then must examine the knock-on impact and how we make up the difference to those who are more affected.

I liked Senator van Turnhout's comment on the red herring which introduced fish into the cheese debate. There should be no more mention of cheese. It is on the third shelf of the food pyramid and it is nutritious. We are talking about the top shelf of the food pyramid and cheese should be out of the argument.

Deputy Fitzpatrick asked how to help the constituent who is clearly in trouble and whose children are also physically struggling but on a smaller scale. That demands the kind of measures that have been discussed and it demands partnership and knocking our heads together. It also demands treatment. I would love to see Senator Crown stand over a prevention of cancer programme that involves no treatment. At the moment that is what we have in Ireland. We are talking about prevention but Deputy Fitzpatrick and others can offer practically nothing to the constituent who walks in the door. That situation has to change. One of the recommendations I would love to see as a result of today's meeting would be that prevention is the way forward but we must be able to treat our obese kids and adults and that is not happening at the moment.

Mr. Chris Macey

I wish to respond to Deputy Colreavy's question about our position on fat tax. While many unhealthy foods are taxed at the standard rate, many others are anomalies and are taxed at a reduced rate. For example, the 13.5% rate applies to croissants, banoffi pie, chocolate chip biscuits, Jaffa cakes and jam doughnuts. The zero rate is applied to foods such as frozen chips, pizza and chocolate spread. We are calling for those anomalies to be removed in the next budget. In the future we will be very strong proponents of a fat tax. However, we try to base everything we do on the available evidence. We believe there are very compelling reasons for the introduction of a tax on sugar-sweetened beverages if the interests of our children are to the fore. There is some evidence about unintended consequences of fat tax, such as people may move from a high fat diet to a high salt diet. There needs to be some clarification at this point. We do not want to give industry a stick to beat us with. We are worried about the regressive elements of a fat tax which may impact on people. Further investigation is required on these points.

Ms Maureen Mulvihill

Professor Donal O'Shea is chair of our nutrition council and he has answered Senator van Turnhout's question very well. His response echoes what I said in my presentation that it is the foods at the top of the pyramid which are high in fat, sugar and salt which give us cause for concern. I wish to add to what the Chairman asked about how to identify foods from the top shelf and how to create a more informed consumer. Allied to the calorie count on menus in catering establishments, the Irish Heart Foundation, along with many public health allies both here and across Europe, has called for a traffic light coding system on the front of packs.

This would allow customers to see, at a glance, whether a product is high in fat, sugar and salt. The new regulations being introduced in 2014 include provisions relating to back-of-pack data. This will add a huge amount of information, but consumers will still have to process all the different numbers. Guideline daily amount information is permitted on the front of pack, but numbers are more complex to read and take more time to process. We have proposed, in the context of the debate on this issue at the European Parliament, that a combination of GDA information and traffic light coding would be the most effective. Research in Ireland by the Irish Heart Foundation and in the United Kingdom, Germany and Australia confirms that this approach would best aid consumers in identifying whether particular products are high in fat, salt and so on.

Chairman

Thank you, Ms Mulvihill. We will now take questions from members, beginning with Deputy Catherine Byrne.

Deputy Catherine Byrne

I thank the witnesses for their presentations. The challenge we are facing is well summed up in the following statement in the document by Food and Drink Industry Ireland: "Childhood obesity is a hugely complex multi-faceted problem that requires a 'whole of society' response." Clearly, we are all in agreement on this. It is my view that wealth is health - the more money one has, the more open one is to reading food packaging in the supermarket and the greater one's ability to identify the nutritional value of the products one puts on the kitchen table. Some parents, particularly in poorer areas, may find this more challenging. Like most women, I go to the supermarket every weekend and, I confess, often pay little attention to back-of-pack information. I am usually rushing home to do something else or to canvass or deliver leaflets. The booklet the delegates have produced is excellent. It would be very helpful to me, as a public representative, if I were permitted to reprint some of that information in the public leaflets I distribute to communities on a regular basis. This is a concrete way in which public representatives can contribute to promoting awareness of the issues we are discussing. If the delegates' permission is forthcoming, I will be happy to do so.

The booklet advises that a portion of meat or fish should be the size of the palm of one's hand. The problem that springs immediately to mind here is cost. In advance of this meeting, I conducted a review of prices in shops in my local area yesterday. The cost of a small piece of fish, I found, was €3 to €4. That cost would be difficult to cover for a person with five or six children, particularly those, including social welfare recipients, with very small budgets. My survey showed that a package of cooking fat cost 48 cent compared with €3 to €6 for a bottle of oil. We must take realistic approach in all of this, and the reality is that the people suffering most from obesity are those living in poorer areas and struggling to survive on a daily basis. My local butcher told me yesterday that his best-selling product is the cheapest cut of mince, followed by chicken, which includes not just the breast fillet but the small fillet that comes off the back of the bird and from which one must remove the innards. Looking at bread prices, meanwhile, I found an 80 cent difference between the cost of a white and brown sliced pan. This is where the problem lies for the poorer sections of our society.

My children attended a local school in Goldenbridge where the principal, Mrs. Carmel Solan, developed a healthy eating policy some 25 years ago. The rule that children would not be allowed through the door with crisps or chocolate bars had a significant positive impact on the lifestyle of many young people. At the weekends, Mrs. Solan would purchase, out of her own pocket, bags of apples, oranges and bananas in order to ensure that every children would have some nutritious food every day. This was long before initiatives such as breakfast clubs.

I read some interesting statistics in a book which landed on my desk this morning. My cultural background means that a patch in the back garden with a few carrots is the sum of my contribution to farming.

Chairman

That is an important aspect of healthy eating.

Deputy Catherine Byrne

I was astounded to read that 1 million people died in Europe last year as a consequence of being overweight and obesity. Moreover, it is predicted that by 2015, 1.5 billion will have died. Meanwhile, the global diet industry commands a gross annual profit of €13.9 billion. Some of the answers to disordered and unhealthy eating can be found by an examination of that industry. I have young teenagers who, although very slim, are always on crash diets which require them to restrict their food choices severely.

Ultimately, however, the buck stops with parents and it is vital that they have control over what is in their cupboards. My six year old does not decide how my cupboards are restocked at the weekend. As I have said, however, pricing is an important element in this. What is happening in poorer areas is that parents are going for the easier-fix solution. People are buying bags of frozen chips and everything else, or a can of carrots instead of peeling three carrots into a pot to cook them. Education is vital if we are to achieve a change in behaviours. I realise that resources are extremely restricted, but would the delegates consider running a television advertising campaign based on the information contained in the booklet? Television is the most effective medium through which to get any message across because it has very high penetration across all groups, in both poor and rich areas.

I am not a fan of McDonalds but when I went to a birthday party there last week I found it was standing room only. By contrast, there were plenty of tables to be had last Saturday in the small family-run restaurant close to my home where one could expect to enjoy a nutritious, well-balanced meal. I thank the delegates again for their presentations. There is a wow factor to what they are saying. The bottom line, however, is that action must begin at home.

Chairman

I take this opportunity to welcome Deputy Mary Mitchell O'Connor to her first meeting of the committee.

Deputy Mary Mitchell O'Connor

Thank you, Chairman. Dr. Donal O'Shea has spoken about the many difficulties that arise in tackling childhood obesity. I would not like to turn up at Deputy Peter Fitzpatrick's clinic unless I knew my weight was in the acceptable range. I have been on crash diets myself, starving myself to lose a pound or two. As an ex-school principal, I am aware that children are entering school already overweight. In fact, as Dr. Eldin said, increasing numbers of babies are born overweight. I will not say what weight my children were when they were born - suffice to say, they were huge babies. Such children are facing a battle from the very beginning. I agree with Deputy Catherine Byrne that it is a difficult problem for parents to tackle, especially if they do not have the money to purchase more expensive cuts of meat and so on.

I applaud the principal to whom Deputy Byrne referred who brought in apples and oranges for pupils. What is required, however, is a deeper engagement by schools which should begin with training for teachers on nutrition. There is a great deal of misleading labelling and misinformation on what is meant by "low fat" and other descriptors. This type of information must be included as part of teacher training so that it can then be incorporated into the curriculum. It is vital, of course, that any such initiative is implemented sensitively. We all know that overweight children are vulnerable to bullying. Teachers will be aware that they must not be seen, in imparting information to students, to be pointing their finger at the boy or girl whose weight is way beyond the healthy range. Visits by district nurses offer a good opportunity to educate parents regarding healthy eating.

Mr. Macey referred to the necessity of striking a balance between industry profitability and public health. The industry representatives made strong arguments and referred, for example, to the farmers who protested last week. The food produced in this country is of a very high nutritional quality. The problem arises when it undergoes processing and the sauce, salt and everything else is added. The challenges facing the industry must be set against the huge public health issue we are facing. Dr. Donal O'Shea has warned that there is a diabetes epidemic coming down the track which will cost millions, if not billions, of euro to address. That must be taken on board.

As Mr. Macey stated, there must be a balanced approach. As legislators, we must look at it in that light.

I thank our guests for their really interesting presentations. I am going to try to get fitter and eat more healthily.

Chairman

I call Deputy Robert Dowds.

Deputy Mary Mitchell O'Connor

I have one final point. Our guests referred to traffic lights. I read every diet book and every magazine article on dieting, but I do not know what they are trying to say in that context. The message in that regard is being lost.

Deputy Robert Dowds

I apologise for laughing. Someone made an amusing remark.

Deputy Mary Mitchell O'Connor

I hope it was not about me.

Deputy Robert Dowds

Following on from Deputy Catherine Byrne's excellent series of questions, why is it that so much processed food is cheaper than unprocessed foods such as vegetables or bread? I would like our guests to provide an answer because there is something to what the Deputy says.

I was very interested in the remarks on education which obviously has a bearing on this issue. As a former teacher, I am very much aware of the limits of education in getting through to people. It is only part of what is required. We must ban the advertising of unhealthy foods to children. In Sweden there is a general ban on advertising all products - not just foods - to children. This is because advertising is regarded as an abuse of children who are not so well able to assess what they see and hear in advertisements. I would be interested in hearing our guests' comments on that matter. What are their views on the suggestion companies which are allowed to advertise unhealthy foods should be obliged to direct funding towards the advertising of healthy foods?

I appreciate Mr. Macey's comments on various unhealthy foods which do not attract a high rate of VAT. I may mention this matter to the relevant Ministers. I accept that in closing the gaping hole in our finances any moneys collected via the imposition of a higher VAT rate on these foods would only be a pittance. However, I remain of the opinion that charging a higher rate would be worthwhile.

I accept that there is need for legislation in this area. What are our guests' views on how comprehensive such legislation should be?

Senator John Crown

I would like the record to reflect the fact that the joke Deputy Robert Dowds and I were sharing was in response to Deputy Mary Mitchell O'Connor's remarks about traffic lights, etc. It was a joke about driving and had nothing to do with anything we were discussing at this meeting.

Chairman

The Senator is in enough trouble already. He should-----

Deputy Mary Mitchell O'Connor

The Senator would want to be careful.

Senator John Crown

Yes, I should stop digging.

The issue of diet has become a much larger consideration in my professional life during the past decade. At our previous meeting I indicated that I had undergone a road-to-Damascus like conversion on the dietary front approximately 12 years ago, which resulted in my losing in the region of 25 kg. I have largely managed to keep that weight off in the intervening period. My experience gave me an appreciation of the difficulties involved, the skills necessary and what needed to be done. The more important issue, however, is the realisation that people in the profession, particularly those within my specialty, were horrifically ill-informed on the importance of diet. There was nowhere near enough education on dietary issues in the past.

I emerged from years and years of oncology training and experience to become a moderately involved breast cancer specialist on the international stage, but it is only in the past few years that the penny has been dropping with those in my profession on the importance of diet from the point of view of cancer prevention. I do not just refer to diet in this regard but also to obesity and its various causes. I will not discuss all of the details, but I can point out that almost all of the common cancers that are not caused by cigarette smoking tend to have an increased incidence in those who are obese or whose intake of calories is too great. There are even data which suggest that if one has had cancer, the chances of it returning in a lethal secondary form are higher if one is obese following one's diagnosis. As a result of this, I spend a great deal of time discussing diet with my patients. I was doing a rough estimate and reckon that I take 20 dietary histories a week and make the same number of attempts at some kind of dietary intervention for patients whom I identify as being obese. I do so without specialist support for my conclusions. If someone looks obese and I know his or her actual weight, I will discuss his or her diet with him or her.

The results of my efforts in this regard are surprising. My patients are not children; most but not all are middle-aged women. They will often wring their hands and inform me that they cannot understand their failure to lose weight. They state they eat healthily, do not consume fatty foods and only eat modest amounts of bread, etc. When one takes their histories, one comes to realise that while there are foods which are more likely to make one gain weight - a previous speaker alluded to this and I pointed it out last week - there is no food that is safe if one eats too much of it. Likewise, I really believe there is no food that is dangerous if it is eaten in strict moderation. People must understand that merely eliminating sugar and fatty foods from their diets will not prove sufficient, particularly if they are eating four spuds or a great big plate of rice or pasta every night. In many of the patients I see the latter are the principal culprits. My patients are women who, because they have had cancer, buy into the idea of avoiding extraneous chemicals. As a result, they stay away from processed foods and soft drinks. None of this probably makes that much difference to one's risk of cancer if one is consuming too many unhealthy foods - to the point where one has become obese - and one's daily calorie intake is too high. This provides some indication of the challenge we face.

The primary strategies we should adopt should focus on education and regulation. I would be grateful if Dr. O'Shea indicated whether he is of the view that we are spending enough time educating young doctors in matters of nutrition. It is my opinion that we are not doing so. Other than stopping people smoking, the single most important action we could take to decrease the death rate from cancer 30 years from now would be to curb calorie intake. This would have a greater impact than anything we do in the context of screening or treatment. I support Dr. O'Shea in his comments on the lack of treatment. I do not know what is the current position, but when I inquired a few years ago, he indicated that there was a two to three year wait for people to be seen at his clinic and that there was a corresponding wait for the minority of patients who required bariatric surgery. I commented previously that if abortion were available in this country, there would be a ten month waiting list. In that context, a health system which obliges patients to wait three to four years to be assessed and then a further three to four years to be treated is profoundly abnormal. This speaks to the need for a fundamental reform of the health system and the removal of responsibility for managing it from those who currently run it.

As we move forward, we must educate doctors, teachers and parents who need to get the message that systematically malnourishing their children - I am not referring to undernourishing them - and giving them the wrong foods is a form of neglect. In extreme cases, it is a form of child abuse. The traffic light idea has much to recommend it and if there are some foods which are utterly devoid of nutritional value and contain large amounts of calories - people may continue to consume these foods because they have a low-level addiction to them - they should be the subject of special treatment and there should be a total ban on their being advertised. A similar and complete ban should be introduced on advertising alcohol. Social pressure of this nature can work. The debate in which we engaged in respect of people smoking in cars in which children are present has had some effect. This is now something which people are reluctant to do.

In the incentivising good behaviour and disincentivising bad behaviour I intend to bring before the committee in the near future a proposal to make the entire Leinster House campus a smoke-free zone. I know Deputy Michael Colreavy who referred to this matter will support me in that regard.

I am not so certain about using taxation measures to deal with this issue. The idea of taxing people to modify their behaviour is one about which I am somewhat uncomfortable. I do not understand why poor parents who provide their children with proper nourishment six days a week and then take them out on the seventh day to see a movie and have a "Big Mac" should pay more.

Deputy Denis Naughten

I apologise that I was not present for many of the contributions. It is ironic that as I was attending the launch of the Global Hunger Index 2012, at which reference was made to children in sub-Saharan Africa and Asia being underweight and malnourished, the committee was deliberating on childhood obesity in Ireland.

Dr. Eldin made an important point about breast-feeding. He is correct that a baby-friendly environment will help to improve the uptake of breast-feeding. The single biggest step that could improve our breast-feeding uptake in this country would be to allow public health nurses to have the time to assist new parents with breast-feeding, especially in the first couple of days after they come home from hospital. The difficulty at the moment is that they do not have the time. As a result of that breast-feeding numbers will begin to fall rather than increase.

I will give an example of what is happening at the moment because of the cutbacks. One woman wanted to contact the breast-feeding specialist as she had a particular problem on a Tuesday. The message she got is that she could contact the breast-feeding specialist between 2 p.m. and 4 p.m. on Thursday. By Thursday, she was bottle-feeding the baby. That is the challenge that currently exists. It is a simple thing. We have the professionals and the know-how and we have women who are willing to breast-feed but they need support and basic time would make a significant difference in that regard.

The biggest single challenge to the food industry currently is information. If one were to ask the committee members what is their target calorie intake, very few would know it. We must address the issue. People know what foods are healthy and what foods are not healthy but they do not know what should be their target calorie intake on a daily basis. Such information would assist people. Deputy Byrne’s point about price was correct but it is also a matter of information and convenience. We must make healthier choices the easy choice for people to make. A campaign was run two weeks ago by Bord Bia in which a cookbook was distributed in one of the national newspapers on wholesome foods. Many of those dishes were quick and easy to prepare. Much more focus must go into the area.

Portion size is a big challenge for the restaurant industry. One can go to a restaurant with healthy options on the menu but when one asks for the children’s menu one finds chicken nuggets and chips and sausages and chips. In some restaurants it is nearly impossible to get a half portion of the adult dishes. The only option is the unhealthy choice for children. The adults can have the healthy choice but not the children for some bizarre reason. More must be done to assist the restaurant industry in that regard. It is a matter of information for them as well. In fairness to the FSAI and the Nutrition and Health Foundation, they are doing much work in that area.

Labelling is a significant challenge for us because one sees food products advertised as 95% fat free, which means that they are 5% fat, which is a significant amount of fat. How it is being advertised, promoted and labelled is a big part of the problem. There is much merit in looking at an amalgamation of GDA and traffic light labelling to provide people with clear choices because if they had the choice people would make the decision if the product is cost competitive. When they do not have the basic information it is difficult to do that.

Dr. John Devlin

Listening to the discussion shows the complexity of the issues. Deputy Byrne’s first point related to the inequality dimension of the issue. We are conscious of that. It is something we would like to discuss with the industry in terms of what we can do also. It does start in the home. I do not like to use the term an "obesegenic environment" but the committee will know what I mean in that everywhere we go we see food outlets and when one turns on the television there is a considerable amount of food advertising directed not at adults but at children, in particular those under the age of eight who cannot make cognitive decisions as to whether a food is good or bad for them. They will not look at the back of the pack and work out the GDA to see whether it is within the recommended daily calorific intake. One has to deal with all of those issues.

In terms of the tools and levers available to us, we must consider education and what more we can do. We have produced healthy eating guidelines but the fact that the committee did not know about them shows that perhaps there is more we can do even though we have produced tens of thousands of booklets. We would welcome the support of the committee in making them more available. It is true that we do not have a large social marketing campaign so we must be innovative in terms of how we get our message across. Meetings such as this one are helpful.

Deputy Dowds made a point about regulation. There is a hierarchy of approach and we like to try to start with education and awareness. Co-regulation might be a good approach but regulation must be at the top of the scale. A good example is caloric posting. The Minister indicated that we will start on a voluntary basis and try to rope in as many restaurants as we can. We will try to be practical in our approach. We will start with restaurants that have menus that run for more than 30 days. We are not talking about zooming in on the one restaurant that produces a single menu every night and the difficulty in that regard. We are trying to be practical but if we perceive the process is not working on a voluntary basis regulation is somewhere at the back of our minds. All of these levers are available to us. It is not just education and regulation. Pricing is important. I did not want to let the remark slide in case anyone felt that many countries in Europe are going away from the notion of a sugar tax or a fat tax. Many other countries are considering introducing it. The matter is very much on the EU agenda at the moment in terms of looking and learning from the experiences of other countries. This is a work in progress. The EU is very interested in what we are doing in this country about a health impact assessment. It is the first of its kind in the world. We will be able to learn a lot from it and we will also be able to export our learning not just to the European Union but also to the World Health Organization which is interested in seeing what happens.

The availability of foods and products must be taken into account as well. The point was made about whether we should segregate unhealthy foods, which would be challenging but it is one of many things that have to be considered in the same way as the approach we took to our alcohol policy. Senator Crown referred to people eating healthy food. It is all very fine eating a healthy chicken but a bottle of wine on top of it negates the overall effect in terms of what one is trying to achieve with calorie intake and a healthy diet.

A number of references were made to physical education. I will ask Dr. Woods to speak about some of the things happening in that regard.

Dr. Catherine Woods

There are two sides to every coin. I have heard a lot of discussion around nutrition and a lack of discussion on physical activity. I wish to draw the committee’s attention to the fact that 86% of primary and post-primary school children are insufficiently active to benefit their current and protect their future health. One could ask why that is important. It is important because physical activity will protect one’s heart and lungs, develop mental capacity and allow one to perform better in school and it will help one in social circumstances. It will also address obesity. It is a behaviour that has massive health consequences if not adhered to. Inactivity – sitting - as we are all doing right now and have been for some time, is the fourth leading risk factor for premature mortality in the world. We need intervention. Dr. Eldin referred to the physical activity plan, which I urge members to read. It explains exactly how we might go about addressing the problem of inactivity in a concrete way where we use a multi-sectoral approach but it tells us how to do it using evidence from around the world. We have consulted with the WHO and everybody on the issue.

Intervention is needed on children. One could ask why and where it is needed. It is needed because of high levels of inactivity but we can do it in the home. The vision in the plan is that children are born into active families with active brothers and sisters, active parents and active aunts and uncles. The vision in the plan is that there would be an increase in the frequency and quality of physical education in the school, where only 10% of primary and post-primary children get the recommended minutes of physical education every week.

It recommends that breaktimes, in a whole-of-school approach, are long enough that children do not need to eat their lunches quickly and have time to go out and play. They learn and develop all the decision making skills and social skills on the pitch that are important for the education of our children. We want interventions in communities with speed limits that allow children to walk and cycle to school safely. We want footpaths and cycle lanes, and coaches who are trained in how to work with children. We should put children first and sport second every so often, with increases in participation in recreation. We want professionals who advocate for a physical activity world. We do this in a unified way through a national plan through which education talks to health and transport, so to speak, to ensure that when a child leaves his or her home every decision is thought about and active choices are made, which are the easy choices.

Deputy Byrne referred to the principal and her healthy eating vision. Would it not be wonderful if that vision was also to do with physically active children? Being active was part of what we were when we left school, as well as acquiring our junior or leaving certificates or other skills.

Senator John Crown

Do any of the witnesses believe that, historically, people's concern about eating disorders in young people, especially young girls, made them shy away from discussing and tackling weight? There was a spurious psychological movement which said that we must not let children worry about their weight or we might feed eating disorders.

Second, in terms of activity, would it not be simple to make it a part of the standard operating procedure of every school that students would spend one hour of every day in school standing up? They could stand up in class for half an hour in the morning and half an hour in the afternoon. We know that standing is a form of exercise compared to sitting and there are many classes which would lend themselves to that, in which people could stand while holding a book rather than sit a desk. If that was done twice a day it would be an hour of augmented physical activity.

Dr. Donal O'Shea

On whether we will have an outbreak of anorexia in response to highlighting children's weight, that point has been made and we come across it regularly talking to parents. It is a mistake. Anorexia nervosa is a psychiatric disease. The tool is food but it is not a food-related disease.

In terms of increased physical activity in the classroom, this is part of the cross-sectoral approach. Wake Up Shake Up programmes are in place in some schools, under which children stand up and do some musical dancing in between classes. We mentioned the green school. There is an active school programme that is trying to encourage all of that but it must be embedded in schools across the entire country, and that will involve resources.

Chairman

Senator Eamonn Coghlan's programme is in place also.

Dr. Donal O'Shea

Senator Eamonn Coghlan's programme is one part of that.

I will briefly respond to each of the comments. The personal responsibility comment from Deputy Byrne is critical. One of the big problems is that parents do not recognise their child is overweight until it is too late. By the time they recognise it they are in serious trouble, as the child has an 80% chance of being obese as an adult because if it is let happen it tracks, so to speak.

To respond to Deputy Naughten, the role of the public health nurse in breast-feeding and monitoring will be critical. Currently, we weigh children up to the age of four. That is done historically because of under-nutrition. The problem now is over-nutrition. We stop weighing them at the age of four but we must continue doing that and tell the parents that their child is on track or a little over but they should keep it steady because they will grow into it.

On Deputy Dowds's question about banning advertising of unhealthy foods and letting the industry promote healthy options for every unhealthy option they advertise, that is part of the bigger industry health collaboration. The industry has a lot to bring to the table in terms of advertising. Its expertise is fantastic. If industry were to promote Dr. Flynn's guidelines from the Food Safety Authority of Ireland, FSAI, that combination would be magic.

To respond to Senator Crown's point on professional regulation and professional education, one of the recommendations of the obesity task force in 2005 was that education about nutrition and obesity would be embedded into nursing, medicine and all allied health. It is similar to the rest of the 96 recommendations. It did not get the attention it needed because it did not have the political clout from the top. Our waiting list for surgery is now infinite. We have more than 150 people awaiting surgery-----

Senator John Crown

If I sent somebody to Dr. O'Shea tomorrow who was a potential candidate for bariatric surgery and they ended up needing the surgery, how long does he estimate it would take him or her to get as far as an operating table?

Dr. Donal O'Shea

I would not even be able to give them a date. There is some argument about whether our current waiting list exists. I have it. It does exist but I am being told it is not real because all waiting lists-----

Senator John Crown

What entity is telling Dr. O'Shea the waiting list may not be real?

Dr. Donal O'Shea

I am in the process of trying to reinvigorate the process. We sent a letter to transfer the bariatric surgery, in line with all international recommendations, to St. Vincent's Hospital six months ago. The letter went to the Minister and to the special delivery unit asking that they get us going but the question now is whether that waiting list exists. I am not sure where that question is coming from but we are trying to sort that out.

Senator John Crown

This is very important. Does Dr. O'Shea have a document that asks if the waiting list exists? If he does, it should be in the public domain. This is very important.

Chairman

That issue is not on the agenda today. We will come back to it.

Dr. Mary Flynn

I want to address the concern about fear of fatness, tackling obesity and making sure we do not stimulate eating disorders. I concur with my colleague, Professor Donal O'Shea, that eating disorders are at the very severe end of a spectrum but there is a huge problem with fear of fatness, particularly among teenage girls and women. Professor O'Shea will take diet histories but they will be heavily influenced by under-reporting because we make people so uncomfortable about the whole issue of overweight and obesity they do not tell the truth about what they eat.

I have a concern about the focus on obesity. We must be careful and take people to task in this regard. When there is anything in the media about obesity the most unflattering photographs of women and children they can find are made public. They should be called to task over that because that stigmatisation is a prejudice against the very people who need to take action. When we call for, say, the promotion of healthy eating guidelines we should not have the skinniest people in those campaigns but a mix of people, which reflects the reality. Before we go forward with any campaign we should ask overweight men, women and children if it would encourage them to take action because if it makes them feel like hiding under a rock or burying their heads in the sand it will not do any good. There should be a call to action about the fear of fatness. We need to include the body image and be aware that we make people feel ashamed. Parents are terrified that somebody will say their child is obese or overweight because of what it says about them. We need to understand that psychological aspect to it.

We did research from the mid-1990s up to the early 2000s in which 19% of our transition year students said they would smoke to keep down their weight. They said they had started smoking and would continue to smoke to keep down their weight. That is how terrified they are of putting on weight, and that is not within the eating disorders group. We were surprised that 15% said they induced vomiting as a weight loss strategy. Also, with regard to the use of drugs such as ecstasy, it is a reality that people lose weight. We think of their vulnerability but adolescents do not think about what will happen when they are 30, 40 or 50. They are thinking of tomorrow or next week. They under a lot of pressure, and we must be very careful, when we talk about weighing people, that we do it in a manner that does not exacerbate those issues.

Dr. Nazih Eldin

On the last point, we already have a surveillance initiative with the World Health Organisation. We have strict guidelines on weighing children, and they are adhered to.

I will make two points in answer to Senator Crown. Where do I start?

I agree with all Senator Crown said. There are two further points to be made, however. The first concerns chronic disease management. The HSE already has chronic disease management programmes. We have added another one specifically for the area in question. My colleague, Dr. Fenton Howell, leads on chronic disease prevention. We actually recognise what the Senator says and we will be addressing the matter very shortly. We have already produced a paper on the matter and I am willing to share it with the committee, if it wishes.

On the statement that we require education and legislation, I contend we also need engineering. My colleague, Dr. Woods, has alluded to the fact that we have engineered physical activity out of our lives. We need it everywhere in life, including work and leisure, as it is very important.

My last point to Senator Crown is on education and training. This was one of the 24 recommendations in the task force report and it has now been actualised. We have a training programme - it is only in its infancy – and we are training general practitioners. The focus is almost entirely on postgraduates, rather than undergraduates, because it is much more difficult to get to universities. We hope that in the next stage, the period 2013 to 2014, the programme will be part of undergraduate education.

Deputy Naughten asked a question on breast-feeding. I just published a paper on the obstacles to breast-feeding faced by professionals and will send it to the committee. The paper has three objectives, the first of which is to promote breast-feeding among the general population, including the young population. This is very important because there is no culture of promoting breast-feeding in Ireland, be it because of the Famine, religiosity or concepts of decency and covering up. There are obstacles to breast-feeding enshrined in Irish culture and we must overcome them. We must better promote breast-feeding.

The second objective is to support those who wish to breast-feed. I alluded to one or two examples, on which I am willing to expand further.

The last objective pertains to protection. The Government and the HSE must adopt the World Health Organization's international code of practice on breast-feeding substitutes. We are not adhering to it. I am not against formula because it is needed, but it is used in hospitals unnecessarily when babies are born. We spend €500,000 on it but we could reduce this expenditure to €50,000. There are children who need substitutes but most do not. We really need to be stricter on adherence to the guidelines. I am willing to work to this end.

I have already stated my interest. As I said, I am not a politician so I ask the members to forgive me. Everywhere I go as a health promotion officer, I say the most important thing anyone can do to promote and improve his or her health is vote. Owing to this, I believe the members are the most important people because they have a considerable responsibility. Bearing in mind that one in four children is obese, we must not continue to do what we are now doing because we will get the same results. We must be very progressive and active. No country in the world could treat so many people; it is impossible. No country could afford it, nor could industry. Therefore, the only approach is to be absolutely progressive and harsh on all the causes of obesity.

Dr. Cliodhna Foley-Nolan

The members listened last week and this week. The ball is back in their court. As I understand it, they are to produce a report. It will either be shelved or will push things along.

Chairman

We hope we can work in parallel with the work on the task force report.

Dr. Cliodhna Foley-Nolan

The members have heard about solutions and approaches by this stage. It would be very beneficial if they prioritised those they regard as realistic or otherwise. Senator van Turnhout stated we could make this too complex. This is possible. Obfuscation might suit some parties. The matter is complex but we must really focus on the basics. This is what I urge the committee to do.

Mr. Paul Kelly

I will speak very briefly on some of Deputy Byrne's comments and those of Deputy Mitchell O'Connor. The complexity of the pricing system needs to be considered in the round when some of the fiscal measures are under consideration.

Fresh produce, by its nature, incurs an additional cost because it is much more difficult to handle and there is a higher rate of wastage. Seasonality must also be considered. One can find virtually any vegetable or fruit in a supermarket for 12 months of the year. These fruits and vegetables, however, do not exist seasonally in Ireland for 12 months of the year. Therefore, there is a cost associated with their production off-season under glass in Ireland or with importing them from other countries.

Fresh protein, including that in fish, meat and chicken, tends to be more expensive because of the cost inputs. This is evident when one considers the differences between the various proteins. Chicken tends to be cheaper than some red meat products, for example, because the conversion efficiency of the feed inputs is greater. In some respects, therefore, it costs less to use. Such products are increasing in price significantly because of higher feed costs, which are driven, in turn, by factors such as the drought in the mid-western United States this year. Unfortunately, our having a globalised food chain has implications for the consumer in Ireland, including Dublin.

Rather than considering fiscal measures such as taxation and subsidies - our position on this is clear as we have talked about it before - there is a need to consider the margins of end organisations such as fruit and vegetable retailers. There is some flexibility in this regard because there has recently been more promotion of fruit and vegetables. This suggests there is flexibility regarding the margins that are being garnered at end of the food supply chain.

Mr. Shane Dempsey

I have very little to add. The members will not have seen too many traffic lights on produce in the Irish market because guideline daily amounts are ubiquitous here. It is worth noting the FSAI has lobbied for front-of-packet guideline daily amounts.

I share Dr. Foley-Nolan's view that the time for action is now. There are many solutions, and we have all suggested them. The members need to identify in their report the actions that need to be taken and they need to prioritise them. From our perspective, a priority is establishing the Live Well platform. There are four or five clear and key activities that must be stress-tested for use. Industry is ready to go.

Chairman

I thank the witnesses for attending, for their very comprehensive presentations and for answering questions. I thank the members. I remind the latter that the questions for the Minister for Health and the HSE, to be answered at the meeting on 15 November, should be submitted to the secretariat before the close of business today.

The joint committee adjourned at 12 noon until 9.30 a.m. on Thursday, 18 October 2012.