My first patient of the year was almost 40 stone
Under-12s need gastric band, by-pass surgery One woman too fat to get out the front door of her own home X-ray machines in our hospitals are super-sized to fit obese patients
Ireland's top obesity expert, Professor Donal O'Shea, has likened the Government's inaction on childhood obesity to the Vatican's handling of the child sex abuse scandal.
In a hard-hitting interview with the Sunday Independent, he said: "The Vatican got into a lot of trouble for doing nothing about child abuse. And the child abuse was endemic in certain parts.
"The Government will be looked at equally harshly in 30 years' time for doing nothing about child obesity."
His comments come as he revealed how children under 12 now need gastric band and by-pass surgery.
"Ten years ago, we did not envisage having obesity surgery for children. We are now asking that obesity surgery is built into the plans for the new children's hospital."
With Ireland firmly on track to become the fattest nation in Europe by 2030, he said his first patient of the year, a man in his 30s, weighed in at almost 40 stone.
"At this stage I thought I was beyond going 'oh my God, look at the scale of the problem' and I was sitting there thinking 'this is the first case of 2015 and it is nearly the biggest person that we have ever seen'."
In a situation similar to cases first seen in the United States, the endocrinologist and his team are also beginning to visit people who are too fat to leave their home.
"We had one lady who literally couldn't fit out the door and she had to be… the emergency services had to go and she had to be transferred to us in hospital."
The woman, who weighed 30 stone, was immobilised due to an injury and, Prof O'Shea explains, "got bigger and bigger and bigger".
"Severe obesity is measured by a Body Mass Index of over 40. She had a BMI of 115. She was quite short and incredibly wide, which was a problem."
Special X-ray machines have now been purchased by the HSE for Irish hospitals to accommodate bigger weights. "They have had to increase the diameter of the round 'doughnut' people go into for their scans, so people can actually fit, and we also have an open arm scanner in Naas that we don't have a weight or size limit on. There are some people at the extreme end that need that."
Prof O'Shea says the food and drink industry, which is "predominantly owned by the same people who own the cigarette companies" are using inventive strategies to grow their base of "heavy users", despite knowing the untold damage they are doing to the nation's health.
"I have spoken to executives of fizzy drinks companies who don't let their kids consume the product because they know it's not good for you. They know kids shouldn't be drinking [this]."
Describing the targeting of Irish children through marketing and social media as "planned, harmful and cynical", he says more and more companies are now using bookmakers' tricks to entice customers.
"They know that the 'bliss' point [in taste buds] is sweeter the younger they have you, so they have to get you [young]... Their marketing is brilliant. If you go back to the little toys that were in cereal boxes that would encourage kids to shake more out in the hope of getting the prize, to what we have now, which is Tayto advertising 'win a trip to Ibiza'. The part of the brain which responds to gambling is the same part which responds to high-fat, high-salt foods. So when you do a double hit - a packet of crisps combined with a flutter - it significantly increases your compulsion to buy.
"I saw an ad on Dublin Bus the other day for a pizza take-away company that said 'Munch your way to New York'. That slogan, in 2015, in the middle of an obesity epidemic that is killing 4,000 people in this country every year and causing massive type 2 diabetes, massive cancer, massive heart disease...? It's incredible."
He also hit out at the use of national heroes to entice children. "The use of celebrities to market is clearly targeted at kids - the Robbie Keanes, the Brian O' Driscolls - they are to attract the young people.
"Under the age of 11, the Santa Claus principle applies in that everything is true. So Robbie Keane endorsing McDonalds or Brian O'Driscoll as a Coca Cola ambassador creates a link between Coca Cola and McDonalds and sporting success."
Asked whether Ireland's top sports stars should stop doing sponsorship deals with junk food companies, he said:
"I absolutely think that sports stars and role models, but sports stars in particular, I think they are being used by the industry. They have a shelf life of their own which is not a long one so they need to capitalise while their image is current."
But he reserves his harshest criticism for the Government. "I think we have yet to see real attitude and teeth from the Government in truly tackling the obesity epidemic.
"We have foot and mouth disease? We close the airports and everyone has to walk through specialised areas to clean their feet when they're leaving the country. For Ebola, we have emergency meetings and task forces and the death toll from Ebola in Ireland was never likely to be more than single figures - and yet we have a condition killing up to 4,000 people a year and we have that vending machine sitting outside there," he points to a machine full of sugary drinks and junk food which has been set up just outside his office, at the Diabetes Clinic at St Vincent's Hospital, in Dublin.
"When our obesity surgery programme was cut last year … it was the only time in my professional career that I have been boiling with rage." Now, he says: "I have reached the point of numbing myself."
Following one presentation to the Oireachtas Committee on Health, he says: "One of the senators came up to me afterwards and said: 'Look, that's really good, but Lucozade Sport are in my constituency.'"
When asked if Taoiseach Enda Kenny is taking the crisis seriously, he said: "Enda Kenny joined up with Operation Transformation for their male cycle, he promotes physical activity ...where it counts as a policy level? No."
He went on: "If we are to learn from the harm to children that 'Vatican inaction' perpetuated, at the moment 'government inaction' is perpetuating the ongoing harm of our children by an environment that the Government are profiting from and it has to change." Wiping out childhood obesity, he believes, is the key to tackling the problem, which he says is a "massive class issue".
"There is a severe problem with child obesity in the less well-off parts of society, we have those figures, the cohort of kids that were abused back in the 60s and 70s were the less well-off and less educated. The top level knew it was happening as the Government do [now about obesity].
"We are not really doing much about it, we are blaming the parents, are blaming the kids when it's actually a complete environmental problem and the Government are profiting.
"If you are well-educated and well-informed you can do something about it, you can resist that environment, but if you were actually abused by the environment yourself you are powerless because it just becomes the norm."
Prof O'Shea also warned against Rosanna Davison's advice to follow a plant-based diet, describing it as "a bad idea" and "dangerous".
"If you want to support a skeleton for almost 100 years you need calcium. It might be okay for a cow who is gone by year .... you know those bent over, osteoporosis women going up to get communion…? All the evidence we have is that vitamin D and calcium are critical for maintaining bone mass through life and you need to do that in the safest possible way and I don't think you can get it from a plant-based diet," he said.
Asked if he is terrified of the prospect of Ireland becoming Europe's fattest nation in 2030 he smiled: "I'll be a year or two from retiring."
He is fighting an uphill battle, but in the long term, the problem is all ours.