January could be a lovely month with a stretch in the evenings and days an hour longer than at the winter solstice. However, there is so much hype about diet and exercise that sensible adults want to go to bed and pull the duvet over their heads.
Newspapers, magazines, television and radio are full of ads and programmes about losing weight and being more active. RTÉ is one of the worst offenders and Operation Transformation overkill is back on TV screens. The experts are in advice- giving mode telling us all what we are doing wrong. Ray D'Arcy calls it "a huge juggernaut of a programme" and it is, but not in a good way. It rolls over people with weight issues, flattening self-esteem.
Like poverty tourism, the show is something to gawp at without understanding the issues involved. A survey carried out post-show in 2013 found that 67 per cent watch the show for entertainment and just over a quarter of viewers want to lose weight or get fitter. Did RTÉ ask behaviour change experts if Operation Transformation-type programmes actually work? There is convincing evidence that they do not work or, at best, have a short-term effect.
Healthy weight
As far as best health-promotion practice is concerned, the show is in the dark ages. The experts constantly refer to Ireland being on course to be the fattest country in Europe. What is the source of this information? In fact, more Irish people are a healthy weight than eight years ago. The Healthy Ireland Survey 2015 found that 60 per cent of adults are overweight or obese compared with 64 per cent in 2007. Thousands of individuals had their body mass index (BMI) independently measured for both surveys so the figures are reliable.
The 2015 European Health Report – Targets and beyond: reaching new frontiers of evidence from the World Health Organisation – puts Ireland in eighth place for overweight and obesity: healthier than countries such as Spain, France and Cyprus, with their Mediterranean diets. The report says nothing about which country is on target to be the fattest.
The training of general practitioners, dietitians, fitness experts and psychologists does not equip them to promote health from a population perspective, which is a separate field of expertise. The model of behaviour change used by the show is unsustainable in the real world.
Viewers may get the mistaken impression that they need eight weeks of multidisciplinary intervention from four experts, whereas a nudge from a GP or other health professional is all most people need.
Nudges are known as brief interventions and the 2016 HSE Service Plan prioritises, rightly, this way of helping people change. Brief interventions are best health-promotion practice and are one of the most effective of all healthcare interventions. The HSE will implement its National Brief Intervention Model during 2016.
Sugar tax
Operation Transformation
focuses, wrongly, on individuals instead of the obesogenic environment. Fat people are not to blame for their condition. The food industry has been allowed to produce and market energy-dense, nutrient-poor foods for more than 50 years with virtually no controls other than an obligation to provide information on labels.
Thirty years ago the World Health Organisation decided that individual education was not an effective way of helping people develop healthy lifestyles. It developed the 1986 Ottawa Charter which puts responsibility for creating health on policymakers, legislators, and the public and private sectors. The charter wants healthy public policies such as sugar taxes, environments that make the healthy choice the easier choice, strong communities, personal skills such as self-efficacy, and health-promoting health services. The HSE has started this process and wants to “make every contact count” from a health- promotion perspective.
The experts on Operation Transformation claim that the show "has the potential to have the same impact as the smoking ban". It does not. Tobacco controls in Ireland are a mixture of comprehensive public policies and legislation which have been very effective. Only 19 per cent of citizens now smoke compared with 29 per cent in 2007.
Operation Transformation is an entertaining reality show and nothing more, so let's not kid ourselves that it's a great public health success story. RTÉ could do better.
The Government must also do better and introduce the same controls on food as it did for smoking, banning all food advertising and taxing sugar. If this happens, even more people will be a healthy weight by the time the next Healthy Ireland survey comes around in a few years’ time.
Dr Jacky Jones is a former HSE regional manager of health promotion and a member of Healthy Council Ireland. drjackyjones@gmail.com