Like the rest of the West, Ireland is suffering from an obesity epidemic that could have drastic consequences for our children. But tackling it will mean a huge political battle, writes Kate Holmquist
Growing numbers of our children will not outlive us, killed instead by an obesity epidemic that is fast approaching a reversal of generations of improved life expectancy. The number of obese children in the Republic has tripled in the past 10 years. Overall, obesity has increased by 30 per cent in the past four years. The EU warned this week that 400,000 European children are being diagnosed with the disease every year, 4,000 of them in the Republic.
Every year, 2,500 people in the State die from obesity-related diseases, according to the Department of Health. This number is set to surge as ever more children become overweight or obese, setting them up for lives beleaguered by chronic, potentially fatal conditions such as heart disease and diabetes. One in five children is overweight and one in 20 obese.
Personal and parental responsibility is a factor, but just as important is the fact that we live in an "obesogenic environment" that is making children sick. Only bold actions will reverse the trend, the National Task Force on Obesity will warn the Minister for Health and Children when it reports next month.
"This is an alarming epidemic. As a society, we don't realise the extent of the emergency because the health consequences of obesity creep up slowly," says Dr Jane Wilde, who represents the Institutes of Public Health on the task force. Obesity is costing the State an estimated €370 million a year.
We may be spending more money on food, but we are not feeding our children as well as our parents fed us. TV viewing and fast food are proving a lethal combination. Our children are not playing as we did in childhood. Physical activity levels are plummeting, as movement is designed out of daily life.
To paraphrase the 19th-century medical pioneer, Rudolph Virchow, all diseases have two causes, the political and the physiological. Obesity is a political disease like no other, as trying to prevent it would engage the Government in a battle of wills with the food industry and other commercial interests.
The task force is convinced that social and commercial influences outside the control of individuals are behind the obesity epidemic, even more so in the case of children who may be unaware of their choices. It wants the food industry to stop producing super-size portions and to discontinue advertising unhealthy foods to children on TV and through sponsorship of children's events.
School tuck-shops and vending machines that build brand loyalty and add girth by selling sugary and fatty treats should be replaced with healthy alternatives. The Department of Enterprise, Trade and Employment must immediately engage with food producers in order to protect children from the advertising of unhealthy foods, the report will state.
Wilde is among those on the task force who are predicting resistance by the food industry to Government regulation, just as there has been resistance by the alcohol and tobacco lobbies. But because food is essential, unlike beer and cigarettes, the State has the ethical scope to be far more prescriptive.
"It is not the nanny State to prevent children being obese. It is the State taking responsibility," Wilde says.
The task force is also demanding a restructuring of the primary-school curriculum to double the time devoted to physical education taught by qualified instructors, increasing PE time from one hour per week to two in primary schools. The curriculum should also include a 30-minute daily physical activity session. In all, children need 60 minutes of physical activity daily and the infrastructural support required to achieve this must be made a priority, the task force believes. For example, every road budget should set aside a percentage for safe cycle paths and walkways.
Taken as a whole, the report's recommendations affect nearly every Government department and hit the private sector in the pocket, challenging everything from the high insurance rates that prevent children running in the playground to new estates that lack safe play areas, walkways and cycle paths.
The report will also pave the way for so-called "fat taxes", advising the Department of Finance to conduct research into links between fiscal policies and the promotion of healthy food choices, in order to determine whether such taxes would be beneficial. The Department of Agriculture must review its policies in order to promote healthy foods and should practise positive discrimination towards local producers of healthy foods, it says. The State will also have to face up to "food poverty" and increase social welfare allowances so that people can afford to purchase and cook healthy, fresh food, according to the report.
The plight of obese children, who will make this the first generation of children to start dying before their parents do, gets special attention in the report. By four years of age, these children are convinced that they are "ugly, lazy, stupid and selfish". The combination of stigmatisation and health problems means that when they grow into adulthood, the one in 20 Irish children who are obese, risk higher unemployment, isolation, lower wages, more lost workdays due to illness and greater psychological problems.
While the report concerns both children and adults, the sections devoted to children are among the most controversial. Ibec, which represents food producers, says there is "no conclusive evidence" that child-focused food advertising is linked to childhood obesity. Anticipating sanctions against advertising junk food to children, Ibec has already set up the Nutrition and Health Foundation, which will undertake its own research into links between TV ads and childhood obesity.
In January, the Broadcasting Commission of Ireland (BCI) introduced a code on children's advertising, banning the use of celebrities to promote food on TV when the child audience is more than 50 per cent (a child is defined as anyone aged under 18). The code also states that advertisements for confectionery and fast food aimed at children must include a message that such food "should be eaten only as a part of a balanced diet".
Rosemary Garth, who represents Ibec on the task force, says the industry has "difficulties" with such restrictions because they are "based on insufficient research". Their impact would be "negligible" because just 48 per cent of the TV children watch is generated by domestic channels.
"The BCI is well-intentioned but misses the point. If you want to tackle obesity, you have to do it in a comprehensive manner," Garth says. "The issue is all about balance. There is an element of personal and parental responsibility involved, and activity levels also play an important role."
However, the World Health Organisation is quoted in the task force report as stating that aggressive marketing to young children could increase the risks of them becoming obese.
The US-based Kaiser Foundation concluded in 2003, after reviewing 40 studies of obesity and TV advertising, that the more TV children watched, the more likely they were to be overweight or obese. The link was due to the messages with which children were being bombarded, not to the sedentary nature of TV viewing, since children who watched less TV were less likely to be obese even when they were just as sedentary, reading or playing board games instead.
Jane Wilde suggests that expecting the food industry to change its ways voluntarily is a non-starter as, by definition, the food industry's business is to develop new foods and niche markets. We don't actually need more food, so the food industry must convince us that we want more food.
Wilde reasons, however, that the economic costs of obesity, particularly in healthcare and premature death, are going to be so high that, at some point, the Government will have no choice but to protect the health of consumers. Measures couldinclude legislation regarding the food messages manufacturers provide in advertising and labelling. One member of the task force predicts that such legislation could be as little as five years away, once the food industry has had an opportunity to comply voluntarily with the task force's recommendations.
The role of active play in keeping children a healthy weight cannot be overestimated, according to Marie Kennedy, who represents the National Children's Office (NCO) on the task force.
The equation is simple: children must expend at least as much energy as they ingest. Yet today's parents fear unsupervised play outdoors, children's lives are more structured, and toys have been replaced by electronic media (while these can be beneficial and creative, they tend to be indoor and sedentary).
Playtime in schools has been eaten into by the demands of the curriculum, notes Kennedy. The shortage of safe walkways and cycle paths means many children are prevented from walking to school. And many have no access to playgrounds, while even the wastelands where children once played are disappearing. Planning decisions must take account of the need for children to exercise freely, the NCO has argued, and the task force has taken this on board. But while the responsibility of the State to build a healthy ecology for children is unarguable, there is still a need for greater parental awareness, according to Kennedy.
"Many parents look in the mirror and don't realise the extra weight they are carrying. So it can be just as hard for them to see that their children are overweight," she says.
Childhood obesity appears, on one level, to be this season's trendy health scare. On TV, Jamie's School Dinners has shown children who are so accustomed to sweet, salty and fatty processed foods that they weep in horror at the sight of a plate of vegetables and meat. Super-size Kids this week included the pathetic sight of a 26-stone 13-year-old furtively eating chips, crisps and sweets even though he was on a monitored weight-loss programme.
But parents need to understand that childhood obesity is about far more than media hype. As the task force report makes clear, our children will die young unless we create a healthier environment for them to grow up in.