One in four Irish children is overweight . . . 10,000 become obese each year . . . Irish girls are among the heaviest in Europe. Those are the claims, but what's the reality, asks Kate Holmquist
When I was first approached about presenting a programme on overweight and obese children for RTÉ's Futureshock series, my initial reaction was: convince me this is really a problem.
Where were these kids? In my mind, obesity meant the grotesque extreme you see in US malls and theme parks. The sort of crippling, deforming extra poundage that makes for sensational TV viewing on the satellite channels. To me, obesity meant people so heavy they need assistance to wash and get out of bed, who need wheelchairs, and who can't lose weight even though their weight is killing them.
I saw around me children with puppy fat and plenty of adults who could lose a few pounds, but this was normal surely. Hardly life-threatening.
The programme's producers suggested that I explore the issue. Maybe there wasn't a problem - or maybe I'd become very, very angry.
Like a lot of parents, I was far more concerned about eating disorders. You daren't talk to kids about weight for fear of giving them anorexia or bulimia. Our children are so paranoid about "fat" that the word has become the worst schoolyard insult.
Secondary-school boys I've interviewed have told me that fat people "don't care". Rather than focusing on weight, isn't it more important to focus on battling the stigma? Our children constantly compare themselves to impossibly perfect celebrities whose airbrushed images are impossible to escape. Northern Irish research has shown that girls crash-diet to look like pop stars, believing that this will bring them success and happiness. This is surely proof that our obsession with body size has gone too far.
With an estimated 7,000 Irish adolescents - according to the World Health Organisation (WHO) - suffering from eating disorders, it seemed to me that our relationship with food had become so dysfunctional that children were convincing themselves they were fat when they were not. Even boys' schools now have teachers on alert for eating disorders. One teacher confided to me her concern that boys were refusing to eat normal food and were living on supplements and protein shakes while they pumped iron at the gym in their attempts to be perfect.
Dr Donal O'Shea, a consultant treating adults with obesity in Loughlinstown, Co Dublin, has the only publicly-funded clinic for obese adults in the country. He says: "I think there's a lot of concern about eating disorders, about kids having an abnormal relationship with food, so that weight is a taboo issue. And that has to change, that has to become unacceptable because we have an obesity epidemic. It is stemming from childhood and adolescence and if we don't get the weight and lifestyle of that population right then we're going to continue on the path that we're on at the moment and just chase America to unreasonable statistics."
There are 300,000 overweight and obese children in the Republic of Ireland, with another 10,000 becoming obese every year. It means that one in four Irish children is overweight or obese. Irish girls aged 13-15 have some of the highest rates of overweight and obesity in the world. They're facing life-long struggles with their weight, heart disease and diabetes, which the WHO has targeted as the epidemic of the 21st century. More than 30 per cent of Irish nine-year-old girls are pre-obese and 12 per cent of seven-year-old Irish girls are obese. By the time they turn 18, many will qualify to be patients at O'Shea's clinic, if they're fortunate enough to live in his catchment area.
I was starting to think that maybe this wasn't just an American problem after all.
DR O'SHEA'S CLINIC is in a temporary outbuilding, hardly a sign on the part of the Health Service Executive (HSE) that obesity is an urgent issue. To accommodate Dr O'Shea's patients, the building has reinforced floors, extra wide doors and double-width chairs. There's an electronic scales with a platform so large you'd think it was for weighing livestock. At the entrance to the building, a wheelchair ramp is evidence of the disability brought on by extreme obesity. Some of O'Shea's patients weigh up to 240kg (38 stone). Dr O'Shea is currently seeing 580 such patients and bringing 200 new patients in each year. Thanks to extra funding from the HSE, the clinic is ahead of target and seeing patients more quickly, yet demand is so great that the waiting list has grown from 400 patients to 650 despite the extra funding. Each patient gets nine months of medical and psychological support because that's all the State thinks it can afford.
There are enough morbidly obese people in the country - those weighing 45kg (seven stone) over an ideal body weight or having a body mass index of 40 or higher - to justify a clinic like this in every large town, Dr O'Shea says. People are sent from other hospitals just to be weighed on his clinic's super-size scales, because normal hospital scales aren't up to the job.
Dr O'Shea's collection of antique weighing scales tells its own story. The average adult has increased in weight by almost 13kg (two stone) in the past 20 years, and the extremes of morbid obesity have increased spectacularly. The earliest scale in Dr O'Shea's office dates to the late 1800s and goes to a maximum of 170kg (20 stone). Until the mid-20th century, this FX Callaghan scale could have weighed just about anybody. In the 1950s, the surgeon George Lyons's weighing scale was introduced. That went up to 140kg (22 stone) and, again, weighed everybody Lyons saw through his 30-year career. But in the 21st century, 22 stone has become a weight that people diet and exercise down to. The electronic scale that Dr O'Shea uses now weighs people up to 240kg (38 stone). He hasn't as yet had a patient weighing more than that.
"The sheer physical burden of carrying an additional 20 stone is unthinkable really. It's like carrying another adult body, or even one and a half bodies, on your back all day. You can't imagine doing it yourself for a day, let alone all the time, and for people who are at that level of overweight just walking around, just breathing demands extra effort." Osteoarthritis from all that strain on the joints brings chronic pain, while heart disease, diabetes, cancer - these are the killers.
DEATH BY AGE 35 is a possibility and the psychological pain is tremendous, both as a cause of overeating, and as a result of the social isolation that comes from being housebound and stigmatised.
One reason he don't see some morbidly obese people, O'Shea explains, is that they're stuck at home. Immobile, unemployable, afraid.
"We're dealing out here with the severe end of the spectrum, which is maybe 2 per cent of the population. The vast majority of people who are overweight and obese don't actually know it. They will look a little bit overweight but they won't actually think for a minute that they've entered into the obese category by its medical definition," says Dr O'Shea. The sort of overweight and obesity that affects one-half of the Irish adult population isn't visible because we've grown used to it. Yet the damage to the heart and the increased risk of cancer is still there. "It's the whole spectrum of overweight and the early parts of obesity before you get to this size that's important," says Dr O'Shea.
The problem is so bad that the HSE is currently negotiating to send Irish patients to the UK for gastric bypass operations. Yet even when their stomachs are reduced to the size of a chicken nugget, morbidly obese people still can't reduce to a normal weight. Their bodies won't let them, Dr O'Shea explains. Their best hope of extending their lifespans to anything close to normal is to lose as much weight as they can and keep it off.
Imagine being a child or teenager and having to deal with that sort of future. With one in four children overweight and obese, so many are headed in the direction of Dr O'Shea's patients that it will overwhelm the health services in the future.
Overweight children are in the last chance saloon. "The right age to get your weight right is as a kid," says Dr O'Shea. "As a child, if you are overweight you have the unique opportunity to grow into a healthy weight. So you have the ability to stretch and keep your weight steady, so you can achieve a healthy weight without losing weight. As an adult it becomes increasingly difficult." Yet many Irish children aren't getting this chance because their parents can't actually see that they are overweight. According to UK research, some 75 per cent of parents can't recognise overweight and obesity in their own children.
IN THE US, parents are becoming proactive. When I told friends that I was going to visit a weight-loss boarding school in the US, their reaction was one of pity and dismay. Sending a child away, in today's ethos, is fairly extreme. What kind of parent is so repulsed by their child's weight that they would ship their child off to be looked after by professionals? What sort of message is that child getting? Doesn't banishment to a boarding school reinforce the stigma? And even if the child does have the benefit of losing weight and becoming physically fit, isn't it inevitable that this child will fall back into old patterns when he or she returns home?
The Wellsprings Academy opened its first boarding school in California in 2004. It opened a second in North Carolina in February 2007 and will open a third in New York state in June. I travelled to North Carolina, with the TV crew in tow, to find out what was going on.
Are these the children of rich, overachieving parents who can't deal with having less-than-perfect children? What surprises me, meeting these kids in their XXXL hoodies, is how badly they want to be there. They are willing to put up with homesickness and a complete withdrawal from their former pastimes of watching TV and shopping - not to mention anything approaching what we now consider to be a "normal" diet. They actually want to be taken away from the pressure of families with distorted eating patterns, from school friends who tease them for being grossly overweight, and from the temptations of fast food, sedentary days slouched over computer games, and everything else that goes with the American lifestyle.
These are kids who know that if they don't change their eating and exercise habits they will be dead by 35. These are kids who, upon arriving at the school, are so unfit that they can't walk up the hill to the dining hall.
The Wellsprings in North Carolina is set in rustic Appalachia and it's a no-frills environment. It is confined, nestled between mountains, making it impossible for the kids to escape to the fast-food restaurants and all-you-can-eat buffets on the main highway.
Each student wears a pedometer to measure the distance they travel by foot, because part of the programme involves taking 10,000 steps per day, the equivalent of about three hours of exercise. They get this by walking and playing games. After several months at the school, some of the children I meet have lost as much as 35kg (5½ stone) and even 50kg (almost eight stone). It's not unusual for a child to lose 4.5kg in their first week. It is strangely moving to see teenage girls running around like little kids playing hide-and-seek in the fields. They are enjoying their new energy, they are finally being allowed to be children in a natural environment.
They don't complain much about the fact that they are allowed to watch TV only while walking on a treadmill. Or that their dinners are made of buffalo meat - high protein, little fat. They breakfast on half a bagel with non-fat cream cheese, artificial scrambled "eggs" and bowls of strawberries dipped in Sweet'N Low, an artificial sweetener - their only indulgence. The school lets them have as much Sweet'N Low as they want. One girl I meet has 20 packets in front of her at breakfast. The psychological director of the school, Mike Bishop, explains that this is a matter of damage limitation. Better to binge on Sweet'N Low than something that actually has calories, since being obese kills far quicker than artificial sweeteners ever will.
The kids tell me about their lifestyles at home - they aren't much different to Irish adolescents. At some point, around the age of nine or 10, their weight and eating habits had got the better of them. They'd spent too much time alone in their rooms, with electronic entertainment and convenience foods, and hardly any time moving around outside - except by car.
IN LONDON, I meet Sir David King, who leads the UK's obesity task force and who published the UK government-commissioned Foresight report on obesity.
He tells me that Ireland, with its new-found affluence, has set itself up for an obesity epidemic, basically following the pattern of the US and the UK, where overweight and obesity are now "normal" - which is why I couldn't see it.
The 2 per cent of the population who become enormously, obviously obese are just the scapegoats, I realise. It's the majority who are less obviously overweight who are slowly killing themselves without even knowing it. The question is: why are so many of us getting fatter? Is it really a matter of personal responsibility? Over the course of dozens of interviews with doctors, the food industry and public policy experts, I get a picture of how complex the problem is and how hopelessly inadequate our response to it has been. That's what the documentary is about: how we are designing our environment to make us fat and how our education and health systems haven't got the resources to deal with the consequences because the State is only paying lip-service to the problem. And how we are allowing the food industry to manipulate our tastes to make us fatter. What I found out was, indeed, shocking. And it has set me thinking once again about our denial of this problem. When you see the evidence, I hope you'll be as angry as I am.
• Futureshock: Fat Nation will be screened on RTÉ1 on Monday at 9.30pm
Size matters
One in four Irish children is overweight or obese.
There are 300,000 overweight and obese children in Ireland,
with another 10,000 becoming obese every year.
Some 30 per cent of Irish nine-year-old girls are pre-obese
and 12 per cent of seven-year-old Irish girls are obese.
Some 75 per cent of parents can't recognise overweight and
obesity in their own children.
The indirect cost of obesity here is estimated at €400
million a year.