The race we
don’t want to win
Tackling Ireland’s obesity epidemic
RCPI Policy Group on Obesity
Irish National Eating
Disorders Conference
Catherine Hayes
Feb 27th 2016
Background
Predictions from UK Foresight Model - 90% of Irish population overweight
or obese by 2030- highest of any European Country
25% of 3 yr. olds, 25% 9 yr olds, 26% 13 yr olds overweight or obese. (Growing
Up in Ireland 2011)
2 out of 3 Irish adults overweight or obese. (SLAN 2007, NANS 2011)
Half of older adults at risk of metabolic and cardiovascular disease based
on waist circumference (TILDA 2014)
Cost of obesity in Ireland in 2009 was €1.13bn; €398m in direct healthcare
costs. (Safefood 2012)
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Royal College of Physicians of
Ireland Policy Group on Obesity
• RCPI has convened a number of policy groups focused on major
national health and wellbeing issues ( Alcohol, Tobacco, Obesity, Sexual
Health)
• RCPI policy group on obesity set up at the instigation of the Faculty of
Public Health Medicine (Spring 2013)
• Group formally established in June 2013.
• Includes practitioners from a range of medical and allied specialties who
deal with obesity in the course of their work
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Membership
Name
Representing
Dr Catherine Hayes (coFaculty of Public Health Medicine
chair)
Royal College of Physicians of Ireland, St
Dr Donal O’Shea (coVincent's University Hospital and St.
chair)
Columcille's Hospital
Ms Cathy Breen
Irish Nutrition and Dietetic Institute
Mr Donal Buggy
Irish Cancer Society
Dr Vivion Crowley
Faculty of Pathology
Ms Maureen Mulvihill
Irish Heart Foundation
Dr Jean O'Connell
Postgraduate Specialist Training, Royal
College of Physicians of Ireland
Prof Humphrey O'Connor Irish Society of Gastroenterology
Ms Pauline O’Reilly*
National Cancer Control Programme
Dr Brendan O’Shea
Irish College of General Practitioners
Dr Gillian Paul
Faculty of Nursing and Midwifery, Royal
College of Surgeons of Ireland
Prof Ivan Perry
Centre for Diet and Health Research, HRB
Prof John Ryan
Faculty of Sports and Exercise Medicine,
Royal College of Surgeons of Ireland/
Royal College of Physicians of Ireland
Prof Michael Turner
Institute of Obstetricians &
Gynaecologists
Dr Cliodhna Foley-Nolan Safefood
Prof Hilary Hoey
Dr Siobhan Jennings
Prof Cecily Kelleher
Faculty of Paediatrics
Health and Wellbeing Division, Health
Service Executive
School of Public Health, Physiotherapy &
Population Science, UCD
Dr Abbie Lane
College of Psychiatrists of Ireland
Dr Andrew Maree
Irish Cardiac Society
Prof Walter McNicholas The Irish Thoracic Society
Mr Owen Metcalfe
Institute of Public Health
Ms Ruth Yoder
Psychological Society of Ireland
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Terms of reference
Overall Aim
• To influence national policy on the prevention and management of
childhood and adult obesity, using evidence based research and best
practice from Ireland and internationally.
Key Objectives
• To raise public awareness on obesity and the obesogenic environment.
• To advocate for national policy measures to address the obesogenic
environment including legislation where appropriate
• To highlight areas of improvement for clinical services in the
management of obesity
• To drive improvements in education and training programmes for
medical professionals to enable doctors to raise the sensitive issue of
obesity with patients and to manage the condition appropriately.
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Policy Statement (Launched Sep 2014)
Aligned with Healthy Ireland
Framework for Improved Health
and Well-being 2013-25
Also reflects recommendations of EU Action
Plan on Childhood Obesity
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Recommendations - Overview
Public Policy Measures
Actions in
Actions for Health
Specific Settings
Professionals
Advertising, promotion
Healthcare
“Making every contact
and labelling
Facilities
count”
Fiscal measures
Education Settings
Pre-pregnancy, first 1000
days and the early years
Obesity and mental
Planning for a healthy
Community
health
physical environment
Settings
Training for health
professionals
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Public Policy Measures
• Prohibition of TV advertising of
HFSS up to 9pm and a ban on
marketing of HFSS foods to
children.
• Monitoring by government of food
marketing, sponsorship, and brand
management directly or indirectly
aimed at children.
• Introduction of a front-of-pack,
traffic-light, food labelling system.
•
Introduction of a 20 per cent tax
on sugar sweetened drinks (SSDs) in
budget 2015 (not introduced).
•
•
Consistent application and
monitoring of local area planning
guidelines on the location of fast food
outlets throughout the country.
Built environment planning that
facilitates and encourages people to
be physically active including
promotion of active travel through
planning regulations and guidelines
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Public Policy Measures (2)
• Promotion of active travel (such as cycle lanes, safe walking
options) thorough continued investment in necessary infrastructure
and support for “smarter travel” plans
• Provision of green areas, playgrounds, and other community leisure
facilities.
• Promotion of greater awareness of these planning guidelines among
communities by the local authorities.
• Encouragement of physical activity in building layout and signage;
for example, ensuring that the stairs, rather than the lift, is the visible
option
• Initiation of a discussion between government (at local and national
level) and communities on the barriers to full use of local sports
facilities and other leisure amenities.
In healthcare, education and
community settings:
• Adoption of a ‘weight aware’ ethos
in all clinical services.
• A commitment from schools to allow free
play and physical activity in school
playgrounds/recreation areas
• Providing a majority (at least 60 per • Use profile and influence of sporting
cent) of healthy options in food
organisations and sportspeople in
service facilities in healthcare
communities to promote physical activity
settings and providing only healthy
and consumption of healthy, rather than
options in children’s units.
unhealthy, food and drinks.
• Better provision of healthy food
choices in school breakfast clubs,
supported by funding, adequate
facilities and promotion of
nutritional guidelines.
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Actions for Health Professionals
Record
• Make weight measurement standard practice with each professional
contact.
• Record overweight/obesity using the same principles as chronic
disease, including BMI above normal range on death certificate
Families
• Provide advice to women and partners on optimising weight prior to
pregnancy.
• Encourage women to exercise to a light or moderate level in pregnancy.
• Emphasise the benefits of and healthyweaning practices with parents.
• Identify and address early instances where mothers are overweight
during the years following delivery especially year 1.
Children
• Monitor growth of all children aged 0-4 years according to the HSE’s
Best Health for Children Guidelines
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The race we don’t want to win
Tackling Ireland’s obesity epidemic
Actions for Health Professionals (2)
Mental Health
• Emphasise the benefits to mental wellbeing of being a healthy weight in
in obesity prevention/ weight management programmes
• Consider that increased weight may be an indicator of an underlying
psychological or psychiatric problem, or the manifestation of depression
or an eating disorder, and refer the patient to the appropriate services
• In managing psychiatric illness, consider the potential for rapid
development of obesity, paticularly in the immediate period after starting
medication, as a side effect of certain drugs, communicate the risks to
patients and/carersand take action to mitigate the effects, i.e.
• Lifestyle advice at each review
• Physical health screening checks
Policy Group on Obesity. August 2014
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The race we don’t want to win
Tackling Ireland’s obesity epidemic
Expert Report 2015
Provide specific behaviour change programmes addressing healthy eating and
increased physical activity using motivational interviewing or similar techniques
for individuals with mental illness within primary and community settings
Subsidised exercise or exercise on prescription programmes must be considered
Educate patients with mental illness on weight management. Training in the
physical and mental factors in the aetiology and management of
overweight/obesity must be provided to all relevant health professionals
Ensure regular improvement in physical health care for people with mental
illness is a key component of current mental health policy.
Policy Group on Obesity. August 2014
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Training of Health Professionals
• Development of an educational programme in the Royal College
of Physicians of Ireland around weight management for all
health professionals (including trainers), with the support of a
lead person within RCPI
• Establishment of a national multi-disciplinary training group to
liaise with undergraduate and postgraduate training bodies to
incorporate core elements of weight management training in
future curricula
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Progress to date
Press statements
• No fry zone – Wicklow Feb 2015
• Royal College of Physicians of Ireland Policy Group on Obesity calls on
other retailers to follow Tesco and remove sweets from checkouts
Published: 23/05/2014
• RCPI Policy Group on Obesity calls for exercise to be included in
strategies to address obesity in older people Published: 18/07/2014
• RCPI Policy Group on Obesity calls for ban on advertising sugar
sweetened drinks to children Published: 01/09/2014
Inputs to Consultations
• National Exercise Referral Framework-obesity listed as separate entity
• Proposed changes to Junior Cycle curriculum on Physical Activity with
reduction from 198 to 100 teaching hours over 3 years
• WHO draft guideline on sugar reduction from 10% of total energy to
below 5%
Progress to date
Publication of Policy Statement and subsequent media attention (TV, radio,
print)
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Progress to date.. continued
• Political Engagement
• Expert Report directly feeds into forthcoming Obesity Policy
• Obesity on Manifestos of all Political Parties
• Obesity included in RCPI talks and training events e.g.
• National Education Day for Doctors in Training- How
judgmental am I? Stigma in medicine Dr Jean O’Connell,
Consultant Endocrinologist, SUVH
• Clinical Update: Obesity - Prof Catherine Hayes
• Public meeting - “Your Health is your Wealth- Prof Donal
O’Shea
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The race we don’t want to win
Tackling Ireland’s obesity epidemic
Progress .. continued
Some evidence of rate of overweight and obesity stablising in
children- but only in more advantaged schools (COSI 2014)
Healthy Ireland Survey, 2015,
7539 participants age 15 and over :
6142 (81% measured Height, weigtht, waist circumference
2% underweight, 37% normal weight 37% overweight, 23%
obese
Policy Group on Obesity. August 2014
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The race we don’t want to win
Tackling Ireland’s obesity epidemic
Healthy Ireland 2015
Policy Group on Obesity. August 2014
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Where to from here?
• Continued Political Engagement through RCPI
• Inputs to Consultations, National Policy
• Obesity Policy
• BAI revised code
• Translate findings of H&W survey into PH action
• Progress Training and Education recommendations
• Continued Media Engagement
• Raising awareness
• Influencing decision makers
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Priorities for 2016
http://health.gov.ie/blog/press-release/varadkar-lynch-publish-health-priorities-for-2015/
23/01 /2015
•
•
•
•
•
Publish Obesity Policy
National Physical Activity Implementation Plan
Public Health Bill, (alcohol and tobacco)
Traffic light labeling,
BAI code to be updated in 2016
Acknowledgements
•
•
•
•
Mairead Heffron, Policy Specialist RCPI
Maebh Ni Fhalluin, RCPI
Kate Healy – Communications group RCPI
Dr Keith Ian Quintyne - Specialist Registrar in Public
Health Medicine, HSE South
• Members of Policy Action Group
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