AS THE prevalence of overweight and obesity in the Irish population has risen over the past decade, there has been an even sharper increase in the number of people who are now within the range of being morbidly or severely obese.
This has led to the development of a whole new range of specialised services around the State to treat what is a serious medical condition associated with type 2 diabetes, heart disease, stroke, certain types of cancer and premature death.
The statistics tell us that 38 per cent of Irish people are overweight and another 23 per cent are obese. Even more worrying, one in five Irish children and teenagers is overweight. And hidden among these figures are at least 120,000 severely obese people.
Overweight and obesity are defined by the World Health Organisation as “abnormal or excessive fat accumulation that may impair health”. A person with a BMI equal to or more than 25 is considered overweight, somebody with a BMI of 30 or more is generally considered obese, while anybody who is more than 45kg overweight or has a BMI of 40 or over is morbidly obese.
The man who is heading up the mission to tackle Ireland’s growing obesity problem, Dr Nazih Eldin, HSE lead for obesity, reminds us that rather than just a term to describe how somebody looks, obesity is a clinical condition with “real and avoidable health implications”.
While prevention of obesity is a key goal, consultant endocrinologist at St Vincent’s Hospital in Dublin, Prof Donal O’Shea, points out that access to treatment for people with severe obesity is a basic entitlement.
He heads up the State’s first bariatric medicine unit, which was set up at St Vincent’s about five years ago. Bariatric medicine is the specialised treatment of obese and overweight patients.
The second of these multidisciplinary units for people who are severely overweight and obese was opened late last year in Galway and there are plans to open three further units, two for adults and one for children, attached to the National Children’s Office in Tallaght.
A joint venture bariatric service between Connolly and Beaumont Hospitals is due to open shortly, and Eldin is hopeful that a fourth unit will be opened in Cork by the end of the year once some funding issues have been resolved.
The provision of hospital-based services for severely obese patients is just one component of the HSE Framework for Action on Obesity 2008-2012– the idea is that they will complement other strategies to reduce overall obesity levels.
Although just over a year in the role, Eldin seems to have achieved quite a lot in a short space of time. He has been working with the Irish College of General Practitioners (ICGP) on the drafting of guidelines to deal with overweight and obesity at primary care level for the first time. These are due to be rolled out to GPs all over the State later this year.
In tandem with the development of bariatric medicine services, he has been involved in putting a massive health promotion programme in place to reduce and prevent overweight and obesity. This involves everything from the sponsorship of active after-school programmes and sporting activities to working with low-income groups in relation to healthy shopping and cooking options.
Eldin is working with five different Government departments to develop a policy on physical activity that they can all have a major role in.
“The obesity issue is not just a matter for the Department of Health, it’s a much broader issue.” he says.
Prof Donal O’Shea hails the ICGP’s approval of guidelines for the management of weight in primary care as the biggest development in obesity services in Ireland in the past number of years.
“This is massive because it’s never been done. Patients have been taken on a case-by-case basis but they’ve never before committed to weigh and measure every patient who attends for consultation.
“While this is fantastic at one level, at another it will identify even more people who need dietary and lifestyle intervention and also bariatric surgery.”
At least 120,000 people in Ireland have a BMI of more than 40, making them morbidly obese, according to O’Shea, and in need of hospital services, “a completely unmeetable need”.
Bariatric surgery (such as gastric banding or bypass) is generally considered suitable in patients with a BMI of 40 or a BMI of 35-40 with complications of obesity such as diabetes, high blood pressure, sleep disorders or arthritis.
“If you only have four units for a disease that’s affecting at least 120,000 people, you are really only scratching the surface,” he says.
“The answer to dealing with the obesity problem is not to set up 100 treatment units, it’s to ensure access to treatment in each area and to put the emphasis on prevention.
“There are a number of community programmes for the management of overweight and obesity, which can help to prevent more serious obesity.”
While O’Shea feels the response to the State’s overweight and obesity problem from the Department of Health and HSE has been comprehensive and planned out, he says the real failing to date has been in the Departments of Transport, Education and Agriculture.
“This [obesity and overweight] is a societal problem. We know from the experiences of other countries that addressing one aspect is not enough, we must address the issue across the whole of society from changing the way food is produced and marketed to ensuring that kids have access to physical activity in schools.”
He suggests that the Department of the Taoiseach should take responsibility for tackling obesity in Ireland or a lead minister should be appointed to do so. And he points to the difference that US first lady Michelle Obama has made through her “Let’s Move” campaign to curb childhood obesity.
Although Galway University Hospital (GUH) has developed a programme for the management of patients with severe obesity requiring medical and surgical intervention over the past few years, Dr Francis Finucane, an endocrinologist with a special interest in the management of these patients, has only recently been appointed to lead the medical aspects of the programme.
“This service is primarily for patients with very severe obesity who have found it difficult to lose weight through lifestyle changes such as increased physical activity and dietary modification.
“Our work will complement that of dietitians, GPs and other health professionals in the community caring for these individuals. We will also work with our surgical colleagues in GUH to identify patients who would benefit from bariatric surgery to reduce their excess body weight,” Finucane explains.
Many of the patients who attend the GUH unit have complications related to obesity, the two most common of which are diabetes and obstructive sleep apnoea.
According to Finucane, “There is good emerging evidence that bariatric surgery puts diabetes into remission in a significant majority of patients.
"A study published in the New England Journal of Medicinein 2007 showed a significant reduction in mortality sustained over 15 years, so this is not just a short-term flash in the pan improvement in weight and diabetes remission."
However, he stresses that surgery is a last resort, which not everybody is suitable for and it’s certainly not “a magic wand” that can change somebody’s approach to their lifestyle and eating habits.
He sees a wide range of patients at the Galway unit, some who have tried numerous weight-loss programmes, seen dietitians and tried novel drug therapies – all with no success.
“It’s very unfair to generalise everybody with a weight problem as being sedentary or lazy. Some people are doing their best with their diet and are physically active, but they just tend to hold onto their body fat for some reason. There are, of course, others who have dreadful diets and are just unaware of the issues.
“However, it’s never too late to get educated and this is why we run intervention programmes here at the hospital and in the community.”
Finucane argues that to modify behaviour on a population level to deal with obesity, the level of accessibility to junk food needs to be altered. He urges the Government to make junk food harder to obtain by taxing it accordingly and warns that if society does not act soon to curb the obesity problem, future generations will wonder why we did not do something sooner.
He believes there is a wide variation in what weight people attain if they eat less and exercise more and it’s important to try to learn more about these variations – some of which may be due to genetic influences – if the obesity crisis is to be properly tackled into the future.
Obesity prevention at ante-natal stage
The primary prevention of obesity has to start before birth through educating parents at ante-natal classes about how to track their child’s weight, according to obesity expert, Prof Donal O’Shea. He believes it is essential that Ireland introduces a standard programme of weighing and measuring every child once a year. This information should then be fed back to the family GP and parents and, if the child is overweight, the parents should be educated on how to prevent obesity.
“A lot of parents are shocked to find out their child is overweight. Some children can hide it very well and children who are overweight grow ahead of time, so by the time they look fat, they can be in real trouble,” he warns.
38% of Irish people are overweight and 23% of Irish people are obese
