Tuesday 25 October 2016

Exercise won't rid society of obesity until we regulate the food we eat

Francis Finucane

Published 29/09/2016 | 02:30

'In outlining the many determinants of obesity in the introduction, no mention is made of excessive consumption of unhealthy food'. Stock photo: Getty
'In outlining the many determinants of obesity in the introduction, no mention is made of excessive consumption of unhealthy food'. Stock photo: Getty

At a time of unprecedented crisis in bariatric services nationally because of a lack of leadership, strategy and resources, the 'Healthy Weight for Ireland: Obesity Policy and Action Plan 2016' was eagerly awaited by many. However, Health Minister Simon Harris's assertion at the launch that it was a "really important" step was true for all the wrong reasons.

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The document is another step - backwards - from meaningful implementation of clinically proven, cost-effective interventions like bariatric surgery for severely obese patients, who are treading water in services that are not fit for purpose.

As a bariatric physician, I spend most of my time in obesity clinics apologising to patients for delays in accessing psychological and surgical care and structured lifestyle programmes that work well but are not resourced. It is a national problem.

This plan was meant to be a sign of progress in the fight against obesity in general and for bariatric patients in particular, but it wasn't. For starters, it is overwhelmingly vague and replicates much of what was already articulated well in 'Healthy Ireland in 2013'. It is aspirational, but lacks conviction. It is poorly referenced.

Just eight of the 60 references are actual scientific papers while the rest are other policy documents and reports, including 13 from the World Health Organisation alone. The plan lacks scientific and technical gravitas and expertise. There is nothing new.

It isn't robust or detailed enough to serve as a framework for definitive actions.

After months of anticipation, its lack of any substance will frustrate healthcare professionals who provide care to those for whom the obesity time bomb has already gone off.

Throughout, a preoccupation with the prevalence of obesity pervades. There are too many fat people. We need to reduce the number of fat people. This is an old approach that hasn't worked. Of course, it is critical to try to prevent obesity in the first place, but why not focus on the environmental determinants of the problem?

It is like the manager of an underperforming football team focusing on points margins, rather than improving the quality of defence and attack.

If we address the environmental determinants of obesity, the prevalence rates will look after themselves. That environmental factors drive dietary and physical activity behaviours isn't clearly appreciated in the report.

As an articulation of the strategy to tackle the most important public health issue of our time, the plan betrays a lack of technical and academic expertise at the heart of this Government's approach to the problem. For example, in outlining the many determinants of obesity in the introduction, no mention is made of excessive consumption of unhealthy food!

Rather, there is a preoccupation with physical inactivity as a causative factor - a whole chapter is devoted to it. Saying our obesity problem is about physical inactivity is like saying that the solution to poverty is for poor people to spend less money.

Of course sedentary behaviour is a major public health problem, but reversing the trend in over-consumption of unhealthy food must be front and centre of any obesity strategy.

If fiscal measures to do this generate revenue for everything else, that is all the better. To say that health-related food taxes aren't meant to raise money is to misunderstand the issues around them. There are pros and cons involved, but the document doesn't consider these. Many authorities on obesity don't believe taxes will work. If they are introduced, that money must be pledged for obesity initiatives. Otherwise, there is no point to them. More importantly, the plan ought to explicitly state this.

We need to deploy all means necessary to fund those services (and wider cycle lanes and cheaper apples), or decide we are not providing them. The Government can't have it both ways.

The focus on physical inactivity and inadequate access to the right food, rather than on obesity arising from the over-consumption of unhealthy food and drinks, is symptomatic of a culture of misinformed, pejorative blaming of fat people. It seems to view overweight people as a burden on society who need to show some restraint and discipline and need to be educated and "empowered to make informed choices".

We can provide all of the education we want, but if we are telling people that biscuits are a good idea for breakfast, we won't be getting out of trouble any time soon. And while parents may be "surprised" at what is in chocolate breakfast cereals advertised after the watershed, they still shouldn't feed them to their kids, no matter how soothing and reasonable the voiceover sounds.

The proposal reads like it was heavily influenced by the food industry and the approach to partnership with industry advocated here is disconcertingly conciliatory. While it might be unfair to say that industry is part of the problem, the failure of the Government to regulate what it sells and what it tells the public about its products is definitely part of the problem.

Unfortunately, the Obesity Policy and Action Plan provides no further clarity of vision than 'Healthy Ireland' did in 2013; it is vague and non-committal and constitutes an unacceptable and dangerous opportunity cost for bariatric patients and for society in general. This is a step backwards in the fight against obesity.

Francis Finucane is a consultant endocrinologist with a special interest in bariatric medicine

Irish Independent

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