Saturday 10 December 2016

Is labelling obesity a disability really what a society so rapidly increasing in girth needs?

Education and personal responsibility should be front and centre in our attempt to deal with obesity, says Carol Hunt

Published 24/04/2015 | 07:29

carol hunt 2
carol hunt 2

Like Eve, I couldn't resist the apple. Unlike Eve, I didn't share it. That's what trying to survive for three days purely on juices will do to you - make you feel guilty for chomping on a nice healthy piece of fruit.

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The idea to go on one of those increasingly popular "detox" diets occurred to me when I tried to fit into my favourite jeans and realised that the weight had crept up on me over the winter.

I'm usually fairly good at keeping healthy and getting the right amount of exercise, but a serious bout of illness in January resulted in recurring fits of vertigo, which made exercise impossible. And so, I ate to console myself. And drank.

Did I mention the Pinot Grigio in front of the telly?

So, I thought I'd try one of those three-day juice diets which are supposed to make you detox, lose weight and feel fabulous afterwards.

Yes, I know that my liver does my detoxing for me - and very well too, when I let it. I also know that starving myself on a juice diet for three days isn't a very appropriate way to "lose" weight.

That wasn't my aim. I just wanted to shock my body into realising that a nice crunchy apple was a gorgeous, satisfying treat (and not a packet of Hobnobs).

And I assure you, on the second day of just liquid juice, I achieved that aim. The apple was delicious and tasted boldly illicit - just what was needed.

But, if we're choosing a diet to go on - and let's face it, we've all tried the cabbage soup and the Atkins only to put the weight back on again - how do we know which one may, or may not, work best for us?

And what about exercise? Where does that come into the equation? With obesity spiralling as a health problem in Ireland - particularly child obesity - how do doctors know how to help patients, who present with health problems that are a direct result of their lifestyle and eating habits?

Just last week, the largest ever study into diabetes and cardiovascular disease (by Vhi) revealed that up to 24,000 Irish people could have undiagnosed diabetes - of which one of the main causes is obesity.

But most of us don't want to hear that we need to eat healthily and take more exercise. These days, many of us expect a pill to cure all our problems.

We are inundated with different diet plans and supplementary pills - all promising fantastic results, usually with dramatic "before and after pictures".

Fatter

The diet industry is making billions of pounds, dollars and euros annually out of us and, yet, we are still getting fatter and fatter.

So do any of these diets actually work? Or do they make us gain even more weight in the long run? What does science have to say about them?

Last week, in a bid to help doctors and experts guide obese and overweight patients who want to try a commercial weight-loss programme, a team of researchers at Johns Hopkins in the US published the results of their review of 4,200 studies for solid evidence of their effectiveness.

What did they find? That very few of them had any scientific basis for their claims (the results are posted in the April 6 Annals of Internal Medicine).

In fact, according to Kimberly Gudzune, assistant professor of medicine at Johns Hopkins, only two programmes, Weight Watchers and Jenny Craig, helped dieters to lose weight and keep it off for at least a year.

Those on Weight Watchers shed nearly 3pc more of their starting weight after 12 months than those not dieting, and Jenny Craig users lost nearly 5pc.

Other programmes, including Atkins, the Biggest Loser Club and eDiets, also helped people drop pounds, but since the studies only lasted three to six months, it is impossible to know if that weight loss lasted.

Participants in the very-low-calorie meal replacement programmes lost more weight than non-participants in trials lasting from four to six months.

But the authors found only one long-term study, which showed no benefit from such a programme at 12 months. The authors noted that very-low-calorie programmes also carry higher risks of complications, such as gallstones.

It's not very encouraging, is it? There is a pitiful lack of analysis of what actually works when a person tries to lose weight and keep it off.

When one considers the dangers that the obesity crisis poses to the health of the world, this is not helping people. But it suits the diet industry, which can earn hard cash out of our desire for an easy cure.

Anyone who has tried to lose weight knows how difficult it is. What's not so hard is putting it on in the first place.

Fast food

How, in one generation, did we all get so fat? What happened to us? Our fast-food, sedentary lifestyle is trumping all the advances we have made in medical science that have been responsible for decades of decreasing deaths from heart disease.

Ailments like diabetes, high blood pressure, varicose veins, heart disease, strokes and a myriad of others, are increasing, purely because we don't know how to care for our bodies any longer.

The rational attitude to obesity would be to admit we have a problem - a problem that we can cure - and go about attempting to solve it. But instead, there is a trend to 'medicalise' the issue.

In the USA and recently in the EU, obesity is now labelled a "disability". So if you end up being so overweight that you are putting your health in danger, it is now somehow akin to being born blind or deaf.

Or being so overweight that you cannot walk down the street without pausing for breath is something that you are stuck with for the rest of your life and have absolutely no control over.

Labelling obesity as a "disability" ensures that people who need help in taking responsibility for their weight management, don't think they can do anything about it - until they actually get to a weight where the only remedy is surgical intervention.

The Hospital Group (obesity surgery and weight loss programmes at www.hospitalgroup.ie) is one of the few places in Ireland where this procedure is offered. I asked managing director, Aisling Holly, if surgery is a last resort or if it's seen as an easy "magic bullet"?

She told me: "Surgical intervention should always be the last port of call for any patient; a patient's dietary history should be thoroughly investigated and doctors should ensure that every possible dietary option has been explored and trialled before proceeding with surgery.

"The general perception is that having obesity surgery is the solution for sustained weight loss. However, in my experience, the surgery is the easy part."

Which, of course, may be the problem. We're too used to the 'easy solution' when it comes to health problems these days. But as Holly warns: "Even with surgical intervention, the patient needs to take responsibility to change and evaluate their lifestyle for a sustained weight loss.

"Patients need to buy into a multidisciplinary approach and work with the team to achieve their goals".

Holly believes that the increase in obesity - especially amongst children - means that "the government need to fast track education programmes, so that people have a clear understanding what a healthy lifestyle is".

She feels this should take place in junior school as part of the curriculum.

She has a point. More than one in four Irish children are now considered overweight or obese. And yet, our health service is unsure how to treat them. Holly tells me that "I struggled in relation to my son who suffers from asthma and has to take steroids. I had to turn to a more specialist doctor when I felt he was gaining weight. He has now lost over a stone and has not had an asthma attack since September.

"So again, the co-morbidities relating to obesity is a concern [yet many] GPs are not expert or informed in the area of childhood obesity."

Childhood diabetes is rising exponentially, but currently Ireland is bottom of the list where time spent in school doing PE is concerned, yet we're top of the table when it comes to time spent teaching religion.

This is inexcusable. And exercise is not just necessary for a healthy body, it's also vital for a healthy mind.

Dr Harry Barry, a GP who specialises in the treatment of depression, constantly points out the importance of regular exercise in the treatment of mental disorders.

Physical exercise releases endorphins - 'happy hormones' - in the brain. Keeping fit quite literally makes you a happier person.

Problem is, exercise is free, you have to do it yourself and it doesn't earn the diet (or the pharmaceutical) industry huge profits.

Most of us would love a magic pill that would keep us at our optimal weight without having to work at it. The bad news is that attention to healthy eating, portion size and regular exercise is essential for healthy living.

The good news is that just about anyone - with enough support and determination - can achieve this. So, grab that apple!

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