Obesity, the human health time-bomb, came of age this year, writes Patrick Wall.
Obesity is one of today's most blatantly visible yet most neglected public health problems; 2004 was the year that it came to the fore in the media as a major issue. It shouldn't really have been news in Ireland as the Department of Health and Children's Slán surveys had been demonstrating that obesity levels in men had increased from 11 per cent in 1998 to 14 per cent in 2002, and in women from 9 per cent in 1998 to 12 per cent in 2002.
When you add in those of us who are overweight but not yet obese the figures are even more alarming, with 66 per cent of men and 52 per cent of women in 2002 overweight or obese, compared to 40 per cent and 31 per cent respectively in 1998.
Consuming too much of the wrong food, and also too much of the right foods, combined with our increasingly sedentary lifestyles are contributing to this major health time-bomb. Alcohol consumption is also playing its part in providing us with calories we don't need and keeping us sedentary.
Every day we have new gadgets to ensure we expend less energy - remote controls for the TV, electric windows for the car, ride-on lawn mowers, escalators and lifts. Industry has responded to the combination of an overabundant food supply and an affluent society and the war is on for what they term "share of stomach" and "share of throat".
Societal trends, including both parents working outside the home, greater commuting distances, longer working hours and more disposable income, have created the demand for added-value convenience products like "ready to cook" and "ready to eat" foods. The formal sit-down meal is on the way out and we are now "snacking" and "grazing".
Cookery is no longer a daily chore, it is entertainment you watch on the telly or a weekend pursuit. More food is being eaten outside the home - we are hot on the heels of the US, where 52 per cent of all food is prepared or eaten outside the home and 15 per cent of all food is eaten in cars, or "dashboard dining". This could never happen in Ireland! It already has.
Several key events have brought the issue of obesity to the boil.
In 2003, a group of New York teenagers unsuccessfully tried to take McDonald's to court claiming its food was addictive and had made them obese. The presiding judge, Robert Sweet, ruled that "it's not the place of the law to protect people against their own excesses".
Certainly, there has been a growing trend towards shifting the blame for the obesity epidemic away from the fast-food sector. Judge Sweet's view is shared by many American politicians and in March 2004, the US House of Representatives voted in favour of legislation which would make it illegal for anyone to sue fast-food companies claiming they made them obese, the so-called "Cheeseburger Bill".
This year, McDonald's reacted and out went super-sized fries and drinks and in came chicken salads, yoghurts and chopped fruit.
The World Health Organisation's Global Strategy on Diet, Physical Activity and Health, which proposed limits on the consumption of fats, sugars and salt, was finally passed by the World Health Assembly in May this year. The strategy calls on governments to take measures to curb unhealthy eating, promote exercise and look at food labelling and advertising.
But many governments which have strong sugar industries, including the US which is also the home of Coke and Pepsi, maintained that the suggestion would restrict trade. Controversy, with profit coming before public health, is always good for a story. (It is ironic, and sad, that the group that produced the WHO strategy, the Global Task Force on Obesity, shares offices in Geneva with the WHO Global Task Force on Hunger).
The EU Directorate for Health and Consumer Protection has also got into the ring. It held a major forum in July at which it was outlined that obesity is a priority for the new Commission. The forum brought together the European food industry, retailers, the WHO, consumer organisations and NGOs to discuss approaches.The industry accepted that it has to be part of the solution if any progress is to be made and the possibility of public-private partnerships was considered although not as a substitute for regulatory intervention.
One really worrying factor is that obesity is conservatively estimated to account for 7 per cent of our total healthcare costs. The most life-threatening diet-related health problems fall into four main areas: heart disease; conditions associated with insulin resistance, such as type 2 diabetes; certain types of cancers, especially the hormonally related and large-bowel cancers; and gallbladder disease.
The likelihood of developing Type 2 diabetes and hypertension rises steeply with increasing body fatness. Confined to older adults for most of the 20th century, this disease now affects obese children even before puberty. Approximately 85 per cent of people with diabetes are Type 2, and of these, 90 per cent are obese or overweight. The non-fatal, but debilitating health problems associated with obesity include respiratory difficulties, arthritis, back problems, skin disease and infertility.
Industry has jumped on the bandwagon and we have no shortage of diet-related products to "help us" regain shape. Pharmaceutical companies are vying with each other to come up with the ultimate diet pill, and food companies have developed a new range of products called functional foods which will relieve us from taking responsibility for our health-damaging lifestyles and diets. These include cholesterol-lowering margarine, immune modulating yoghurt and similar products with ingredients, which are believed to reduce blood pressure or prevent cancer.
Your health, and not your house or investments, is your greatest asset but most adults don't recognise this and don't take enough exercise claiming to have insufficient time. And it is a cop-out to say "its all down to your family history" - although your genes load the gun, your lifestyle pulls the trigger.
Not only are we damaging our own health with our lifestyles but we are giving our children, already bombarded with advertisements and promotions for food products of questionable value, bad example .
Eighty per cent of obese teenagers finish up as obese adults with associated health problems. Yet 78 per cent of Irish kids under the age of 10 spend at least three hours a day in front of a screen, either TV, computer or playstation. Many kids have their own TV and Santa got backache he delivered so many Playstations into Ireland this Christmas.
There was a time when kids asked their mothers "what's for tea?" Now the roles are reversed and the parents say "what would you like for your tea?" Kids are taking their nutritional advice from those well-known nutritionists as Gary Lineker or Posh Spice who endorse products high in salt, sugars and saturated fats.
Young children can find difficulty telling the difference between image and reality, so the issue of these aggressive promotions has to be addressed by both the industry and the regulators.
Sitting in front of screens leaves the kids exposed to ads but also renders them increasingly sedentary. Virtual sport is now more fun than the real thing. Not every child has access to a sporting activity. The GAA is very active across the country and athletic clubs and rugby clubs are playing their part too. But clearly it is not enough as more than one in 10 children are obese.
Many kids are delivered and collected from school, as parents worry they will be involved in a road accident or accosted, or worse. Many schools have insufficient facilities for physical education and fear of litigation has meant that skipping ropes, hoola hoops, skate-boards and even running are banned from many playgrounds.
An increasing emphasis on winning and a focus on elite athletes has meant that if your kid is not on the A team, he or she is on no team. With fear of allegations of child abuse, people are reluctant to become involved in extracurricular activities taking responsibility for teams. Everyone claims to have busier lives but parents need to become more involved - the greatest thing you can give you children is your time, and helping them participate in exercise is an investment in their future.
As individuals we need to take responsibility for our own health and that of our children. At the end of every day ask yourself the question "what did I do for my health today?" Prevention is always better than cure. However, we also need a society that makes it easy for everyone, irrespective of income, to adopt a healthy lifestyle. So the provision of footpaths, cycle-ways, play areas, swimming pools, etc., are initiatives for local and national government. Pilot initiatives to encourage participation in exercise with the emphasis on fun rather than winning have proved successful with both boys and girls. But they need to be available across the country.
Industry has a role and employers need to ask themselves "what are we doing for the health of our employees?" Provision of crèches, exercise facilities and showers for staff who cycle or walk to work should be the norm. Work canteens should offer a healthy range of meals.
Finally, the food and drinks industry has to become part of the solution. Indulgent products should be marketed as treats, not for consumption three to four times per day. Tailored ads targeting children with unhealthy products have to stop. Aggressive marketing of alcohol for young people needs to be questioned. Companies must demonstrate they are good corporate citizens. People have to eat and drink and moderation and balance can deliver a win-win.
Ireland led the world with the smoking ban. Maybe we can do the same for the obesity problem. Let's make a start in 2005.
Dr Patrick Wall is Professor of Food Safety at the UCD Centre for Food Safety and medical epidemiologist at the UCD Institute for the Study of Social Change'