Joint Committee on Health and Children 20Th September 2012 Brief for Secretary General

Obesity Brief for Oireachtas Joint Committee on Health and Children

11th October 2012

Obesity – The Problem

● The prevalence of overweight and obesity has risen steadily in recent times, with 61% of Irish adults now overweight or obese. This trend is also being witnessed among Irish children

● Obesity is a major public health challenge, particularly in regard to diabetes and cardio vascular disease, and the significant burden it places on health spending. The prevalence of overweight and obesity has increased at an alarming speed in recent decades, so much so that the WHO calls it a global epidemic. The problem has been exacerbated as a result of our changing social, economic and physical environment and by a dramatic reduction in physical activity, and changing dietary patterns. Because obesity is associated with premature death, excessive morbidity and serious psychosocial problems, the damage it causes to the welfare of citizens is extremely serious and for these reasons the Minister for Health has established a Special Action Group on Obesity to tackle this growing problem.

● In Ireland, The Growing Up in Ireland survey, 2011 found that 1 in 4 children as young as 3 years of age are overweight or obese and these figures are similar to those found in the Irish survey for the WHO Childhood Obesity Surveillance Initiative and The National Children’s FoodConsumption Survey, 2005. One in five teenagers is overweight or obese according to The National Teens Survey. This is of great concern as there are a multitude of short and long-term effects in not only in childhood but also in later life.

Special Action Group on Obesity

● The Minister set up a Special Action Group on Obesity, comprising representatives from Department of Health, the Department of Children and Youth Affairs, The Department of Education and Skills, the Health Service Executive, the Food Safety Authority of Ireland and Safefood to examine and progress a number of issues to address the problem of obesity. Alone no single initiative will reverse the trend, but a combination of measures should make a difference. For this reason the Group is concentrating on a range of measures including actions such as: calorie posting in restaurants, the introduction of a tax on sugar-sweetened drinks, nutritional labelling, marketing of food and drink to children, the supply of healthy food products in vending machines, the detection and treatment of obesity, healthy eating guidelines and the promotion of physical activity. The Group will liaise with other Departments and organisations in a cross-sectoral approach to help halt the rise in overweight and obesity.

The Special Action Group on Obesity is currently progressing, the following measures:

Calorie Posting on Restaurant Menus

● One of the measures being pursued at the moment is Calorie Posting on menu boards in fast food restaurants and coffee shops. SAGO identified calorie posting on restaurant and coffee shop menus as one of the issues which could have a positive impact in addressing the problem of our rising levels of overweight and obesity and as a means of educating the general public on the calorie content of food portions. The Minister has prioritised calorie posting on menus as one of the key initiatives that will have a positive impact in addressing the problem of our rising levels of overweight and obesity and as a means of educating the general public on the calorie content of food portions. It is a simple concept that will educate the general population on calorie content helping consumers make healthier choices, eat smaller portions and enjoy food without over-eating.

● It is in this context that the Department of Health commissioned the Food Safety Authority of Ireland (FSAI) to conduct a public consultation on the introduction of calorie posting on fast food outlet and restaurant menus. In October 2011, The Minister for Health wrote to Fast Food chains operating in Ireland to request that they introduce calorie posting in their restaurants and received a very positive response. The Minister launched a public consultation process in February 2012, involving the FSAI,which was designed to inform the next steps in the process. The final outcome of that consultation process was launched by the Minister on 4th July 2012.

● In an unprecedented 3,130 responses, top line statistics from the public consultation process indicate that - 96% of consumers want calorie menu labelling in all or some food outlets; 73% of food businesses have also indicated that they want calorie menu labelling in all (37%) or some (36%) food outlets although 25% do not want the calorie menu labelling in any food outlet compared to only 4% of consumers who hold that opinion. This indicates that there is support for this initiative among the general public and also, in fact, within the food industry itself.

● The Minister has indicated that he is very much in favour that the programme of putting calories on menus in Ireland be introduced on a voluntary basis at first, because it is clear from the consultation results that the food industry will need significant technical support in order to implement it. There are a number of issues which SAGO, in conjunction with the FSAIis now addressing, for example, technical support for providing calorie content information for small restaurant / coffee shop owners; priority based implementation; how the scheme might work in restaurants whose menus change frequently etc. Calorie posting has already commenced in a number of establishments and it is envisaged that in the coming months, when these considerations are finalised and the necessary implementation mechanism has been devised it will be further implemented.

● Nevertheless, if a voluntary approach fails to make the desired impact the consultation showed that 92% of consumers and 88% of health professionals supported a mandatory approach for large food service businesses although only 58% of food businesses would support that approach.

Consideration of a Sugar Sweetened Drinks Tax

● The World Health Organisation has serious concerns over the high and increasing consumption of sugar-sweetened drinks by children in many countries. Given, the preponderance of Sugar Sweetened Drinks consumption among children and adolescents, several epidemiological studies have examined the relationship between SSB and weight gain or obesity in this group.

● Given the available evidence, the Department of Health has recently established a Steering Group to oversee the carrying out a Health Impact Assessment on the health and economic aspects of introducing a Sugar Sweetened Drinks tax. The Institute of Public Health will be facilitating the Department of Health with this assessment.

● It is expected that the Steering Group will present the Health Impact Assessment Report to the Ministershortly for consideration.

Revised Food Pyramid/Healthy Eating Guidelines

● The Group have revised the Healthy Eating Guidelines, including the Food Pyramid and these were launched by the Minister for Health on 13th June 2012. They will help inform people about the food and drink choices required for a healthy lifestyle and set out in plain and simple language the food servings the Irish population need toconsume to maintain health and wellbeing.

● Healthy Eating Guidelines for Pre-schools and Primary Schools have already been developed and are being implemented. The Department of Health has been working with the Department of Education and Science in developing Food and Nutrition Guidelines for Post- Primary schools and these will be available this year.

Healthy food and drink choices in vending machines in post primary schools:

● Research is underway in association with the Department of Children and Youth Affairs to establish the use and types of foods and drinks stocked in vending machines in post primary schools. The Food and Drink Industry Ireland and its’ members have met with the Minister and with the Special Action Group on Obesity to discuss the Minister’s action priorities. They have indicated to the Minister that this is an area they are interested in supporting. The Department of Health is awaiting concrete proposals.

Health Service Executive – ICGP Weight Management Treatment Algorithm

● Treatment algorithms inform primary care staff of the steps to be taken with regard to managing obesity, from raising the issue and carrying out an initial assessment right through to counselling strategies, dietary advice, pharmacotherapy and referral. An ‘adult’ algorithm has been agreed with health care professionals and is now available. It is understood that the treatment algorithm for children is at final stages of agreement. These tools will make it easier for health care professionals to monitor and treat overweight and obesity at primary care level.

Opportunistic screening and monitoring of children

● The Special Action Group on Obesity has been discussingopportunistic screening and monitoring with the HSE with a view to earlier detection of overweight and obesity in children. This will improve the identification of overweight children at an earlier age and prevent these children from progressing into the obese category. Obese children will also be identified early and treated.

Marketing of Foods and Drinks to children.

● Good eating habits and therefore good nutrition is crucial to establish early on in childhood.In Ireland, we are fortunate to have a Code of Marketing for Children which includes recommendations for the marketing of foods and drinks to children. The Minister for Health has welcome the revised Broadcasting Act which requires the Broadcasting Authority of Ireland (BAI) to examine advertising to children of foods high in fat, trans-fats, salt and sugar and strengthen the Code as necessary.

Redeveloped Physical Activity Web-site and Physical Activity Plan for Ireland

● There is ample evidence showing that in Ireland, we, like other developed countries, have become increasingly sedentary in our daily lives. We know that 3 out of every 4 Irish adults and 4 out of 5 Irish children do not meet the targets set in the National Physical Activity Guidelines developed by the Department of Health and the HSE in June 2009 and are consequently at risk of developing serious health problems due to inactivity.

The Guidelines which include recommendations for all age groups and levels of ability were designed to help support people to be active every day in as many ways as they can. The basic message is that ‘physical activity is for everyone, and any level of activity is better than none’. For adults, the minimum level recommended is 30 minutes a day of moderate intensity activity, 5 days a week. Children need 60 minutes of moderate activity a day. Research has shown that children tend to be more active if their parents are physically active, so I would encourage people to get the whole family active – it’s more enjoyable that way and it encourages children to develop good activity habits for life.

To promote the Guidelines, a dedicated website - was launched, where in addition to the Guidelines, information booklet and fact-sheets, links are provided to other sources of information and support.

National Guidelines alone are insufficient to increase participation levels and so the HSE has also developed “A Physical Activity Plan for Ireland” to give clear direction for the promotion of physical activity in Ireland and address the risk of developing health problems associated with sustained inactivity. The National Physical Activity Plan which will contribute to addressing this major health issue, is currently being considered by SAGO and the Department of Health.