A Healthy Weight for Ireland’, the Obesity Policy and Action Plan (OPAP), was launched in September 2016 under the auspices of the Healthy Ireland agenda.
The OPAP covers a ten year period up to 2025 and aims to reverse obesity trends, prevent health complications and reduce the overall burden for individuals, families, the health system, and the wider society and economy. Indeed it must be emphasised that every sector of our society has a role in reducing the burden of obesity and the OPAP clearly acknowledges this.
The OPAP prescribed short-term (five-year) targets for overweight and obesity as follows:
- a sustained downward trend (averaging 0.5% per annum as measured by the Healthy Ireland Survey) in the level of excess weight averaged across all adults
- a sustained downward trend [averaging 0.5% per annum as measured by the Childhood Obesity Surveillance Initiative (COSI)] in the level of excess weight in children, and
- a reduction in the gap in obesity levels between the highest and lowest socioeconomic groups by 10%, as measured by the Healthy Ireland and COSI surveys.
The annual cost of the Healthy Ireland Survey, which collects data on a wide range of health and wellbeing issues including those relevant to the OPAP, under current contractual arrangements will be €719,346 (€884,796 including VAT). Through grants, the HSE provides support for the operations of the National Nutrition Surveillance Centre to coordinate COSI.
The OPAP policy prescribed 'Ten Steps Forward' that would be taken to prevent overweight and obesity. A new Obesity Policy Implementation Oversight Group was established in October 2017. The current position with implementing some of these is as follows:
1. Embed multi-sectoral actions on obesity prevention with the support of government departments and public sector agencies
An Obesity Policy Implementation Oversight Group (OPIOG) has been established under the Chair of the Department of Health. It is comprised of representatives from the following Departments and Agencies: Department of Agriculture, Food and the Marine; Department of Children and Youth Affairs; Department of Employment Affairs and Social Protection; Department of Education and Skills; Department of Housing, Planning and Local Government; University College Cork; the Food Safety Authority of Ireland; the Health Service Executive (HSE) - including the National Clinical Lead for Obesity; and Safefood. The OPIOG held its inaugural meeting in October 2017 with further meetings arranged at agreed intervals for the purposes of providing oversight to the implementation of the national Obesity Policy & Action Plan (OPAP).
At its next meeting, the OPIOG will consider the Report on Tackling Childhood Obesity from the Joint Oireachtas Committee on Children and Youth Affairs for the purposes of, among others, aligning both sets of recommendations. In the meantime, the preparation of a Progress Report on the implementation of OPAP is continuing so that it can be considered at this next OPIOG meeting. The development of an annual bulletin or score card to evaluate progress in relation to the national Obesity Plan and dissemination of results, has also been initiated.
The OPAP recommended that proposals be developed relating to the rollout of evidence based fiscal measures, including a levy on sugar-sweetened drinks, in support of healthy eating. As the Deputy is aware the Sugar-Sweetened Drinks Tax commenced on the 1st of May 2018. It represents a positive step in our national policy to deal with the problem of obesity.
2. Regulate for a healthier environment
The development of legislation for calorie posting to support people to make healthy choices is underway by the Department of Health. Currently, a behaviour study on how best to make the posting of calories meaningful to customers and more likely to impact on their behaviours is being finalised by the ESRI.
A number of Government policies aim to support the design and development of built environments that enhance health, wellbeing and quality of life for all. The National Physical Activity Plan (NPAP) and OPAP both require that joint action is taken to promote the importance of physical activity and to reduce the obesogenic nature of the built environment.
In line with Actions 31 of the NPAP and 2.1 of the OPAP, which commit to developing guidelines and support materials for those working in developing the built environment in order to promote the importance of physical activity, and Action 59 of the NPAP which commits to developing a programme of on-going stakeholder communication and engagement, a Stakeholder Forum was held on the 21st of November last.
The event was planned in partnership, with substantial input from three Government Departments, (Health; Transport, Tourism and Sport; and Housing, Planning and Local Government). Work will progress in 2019 based on the outcomes of the forum's discussions.
3. Secure appropriate support from the commercial sector to play its part in obesity prevention.
At its inaugural meeting, the OPIOG agreed to establish two sub-groups for Reformulation and Healthy Eating. Both sub-groups have met on a number of occasions since being established and agreed their Terms of Reference.
The Reformulation sub-group is technical in its work programme. The work of the sub-group will primarily set targets on reformulation of food and drink. It will also make recommendations on addressing reduction of portion sizes and on monitoring and validation procedures.
One of the priority actions under Step 3 of the OPAP was to ‘Establish a forum for meaningful engagement with industry on best practice initiatives towards a healthy food environment’. It is intended to progress this action under the auspices of the OPIOG. And in this regard, a workshop between the Reformulation sub-group of the OPIOG and Food Sector Stakeholders on reformulation took place last September. This workshop provided an opportunity for detailed engagement with key Food Sector Stakeholders on the challenges and opportunities of reformulation in the interest of promoting the health and wellbeing of the population. Another similar engagement has been scheduled for late February.
A code of practice for food and beverages promotion, marketing and sponsorship has also been developed involving representatives from the food industry, advertising sector, statutory agencies, and various Government Departments. It was chaired by the former CEO of the statutory Food Safety Authority of Ireland, and published in 2018. Work on the implementation of the Codes of Practice is continuing.
4. Implement a strategic and sustained communications strategy that empowers individuals, communities and service providers to become obesity aware and equipped to change, with a particular focus on families with children in the early years.
The Healthy Ireland 2018 communications and citizen engagement campaign sought to encourage people to make small, healthy changes under the themes of Healthy Eating, Physical Activity and Mental Wellbeing, and to link them with partner organisations and initiatives providing information and support. This campaign will continue in 2019.
In addition, under Healthy Ireland, the Department, safe food and the HSE run a campaign called START which aims to inspire, empower and support parents to start building and persist with healthy lifestyle habits in the family to prevent childhood obesity.
5. The Department of Health, through Healthy Ireland, will provide leadership, engage and co-ordinate multi-sectoral action and implement best practice in the governance of the Obesity Policy and Action Plan.
As referred to at step 1 above, an Obesity Policy Implementation Oversight Group was established to oversee implementation. New Healthy Eating Guidelines, Food Pyramid and supporting resources have already been published, disseminated and communicated in 2017, including dissemination of the new Guidelines to all primary and post-primary schools.
Work has also commenced on developing Healthy Eating Guidelines for the 1-5 year old age group. As a first step in this work, the Scientific Committee of the Food Safety Authority of Ireland (FSAI) is currently developing scientific recommendations for food based dietary guidelines for 1 to 5 year olds.
New Nutrition Standards for schools, with an initial focus on school meal programmes funded by the Department of Employment Affairs and Social Protection, have also been developed. These Nutrition Standards were published in September 2017. The Nutrition Standards were developed by the Department of Health with the assistance of safe food and the Health Service Executive, in cooperation with the members of the School Meals Programme in the Department of Employment Affairs and Social Protection and the Department of Education and Skills.
6. Mobilise the health services to better prevent and address overweight and obesity through effective community-based health promotion programmes, training and skills development and through enhanced systems for detection and referrals of overweight and obese patients at primary care level.
A Healthy Eating, Active Living Programme has been established as a Policy Priority Programme within the HSE and a three-year plan for the programme has been finalised. The GP contract for the provision of free care to children under 6 years, already provides that the medical practitioner shall take an active approach toward promoting health and preventing disease through the provision of periodic assessments to child patients.
The HSE is also implementing a Breastfeeding Action Plan and a new Making Every Contact Count brief intervention framework which aims to capitalise on the opportunities that occur every day within the health service to support people to make healthy lifestyle choices.
On the issue of nutrition in hospitals, the HSE, in conjunction with the Department of Health and Healthy Ireland, is to roll out a new Food, Nutrition and Hydration Policy for patients in acute hospitals in the coming months. A Clinical Specialist Dietitian was appointed to work across Acute Hospital Services to lead on the development of a National Food, Nutrition and Hydration Policy. A team working at national level, composed of all relevant staff including catering, (managers and chefs), dietitians, management, medical, nursing , occupational therapy and speech and language have worked together to develop the policy. Support and guidance to aid implementation of the policy will be provided in an accompanying toolkit. The policy and toolkit are due for publication and implementation over the coming months.
7. Develop a service model for specialist care for children and adults.
A National Clinical Lead for Obesity was appointed in 2017. This appointment is important in further advancing the implementation of many of the recommendations in the OPAP including the development of a national integrated service model for the health and social care of overweight and obese people and for developing quality assurance guidance for obesity services.
8. Acknowledge the key role of physical activity in the prevention of overweight and obesity.
'Get Ireland Active! The National Physical Activity Plan for Ireland' (NPAP) is one of the key developments arising from Healthy Ireland, and implementation of that Plan is well underway in collaboration with the Department of Transport, Tourism and Sport and a range of other stakeholders. An updated progress report on the implementation of the NPAP will be published in Q1 2019.
9. Allocate resources according to need, in particular to those population groups most in need of support in the prevention and management of obesity, with particular emphasis on families and children during the first 1,000 days of life
The implementation of the Healthy Eating and Active Living Plan within the HSE is supporting work in the education sector, as well as with parents, families and communities in delivering a more co-ordinated approach to prevention and early intervention in child obesity.