Worrying about plus-size models is fiddling while Rome burns - obesity is a real threat
Doctors want to treat obesity as a disease and not a symptom of moral fibre, writes Eilish O'Regan
'Fat-shaming' of overweight people on social media and claims that plus-sized models are helping to fuel health issues are now part of the new debate around obesity.
But they are an unhelpful distraction, according to Dr Francis Finucane, an expert on obesity and consultant endocrinologist at Galway University Hospitals.
This kind of discussion may only serve to further lower the self-esteem of some of his patients who are already distressed by how others judge them, he believes.
"It detracts from some of the more important issues confronting us such as the lack of provision of life-saving, cost-effective care to obese patients or the absence of any really strong policies to address the environmental determinants of obesity.
"To me, worrying about plus-size modelling is fiddling while Rome burns. There are more important issues to discuss," he said.
Dr Finucane, who runs the only publicly funded adult obesity centre outside of Dublin, is particularly concerned at what he sees as on-going Government inertia.
This is particularly evident in delays in providing treatment such as bariatric surgery - commonly known as weight-loss operations - for those for whom excess weight is a life-threatening complication.
It's five months since the launch of 'A Healthy Weight for Ireland 2016-2025', the national obesity policy and action plan.
There is no time to lose as nearly 250,000 of us suffer from the debilitating health risks arising from obesity.
Around 60pc of adults and one-in-four children in Ireland are either overweight or obese.
It is estimated that the cost to society in Ireland of adult obesity exceeds €1bn a year.
But we are now no further down the road of developing a national clinical programme for obesity or the appointment of a clinical lead for it, Dr Finucane added.
A clinical lead is a working doctor with expertise in the area who will use the benefit of their knowledge of the condition and the health system to guide and drive implementation of the policy for the HSE.
We already have these clinical leads in areas like cancer and maternity services. They are key figures in trying to turn policy into action.
The HSE told the Irish Independent the post should be advertised before the end of March, with the aim to have an appointment in mid-2017.
Dr Finucane stressed that the "whole strategy will only make an impact if it is adequately resourced".
He said: "There is no point in appointing someone to a fancy title if all they will do is wring their hands and lament the absence of any care for severely obese patients in Ireland.
"The programme will need to capitalise on the broad spectrum of clinical expertise we have now in Ireland across dietetic, surgical, medical and epidemiological disciplines."
He pointed out that he is "less concerned about the levels of overweight and obesity in my clinics than I am about the length of time patients have to wait to see me and then access other specialty services such as psychology, surgery and structured lifestyle programmes".
"We have made good progress in Galway in developing these services, admittedly with limited resources," Dr Finucane said.
"For example we collaborate with Croi, the West of Ireland Cardiac Foundation, to deliver a structured lifestyle programme for patients - which has won national and international awards.
"In 2016 Oliver McAnena and Chris Collins here (at Galway University Hospitals) successfully delivered a pilot programme performing bariatric surgery on 22 diabetes patients."
This type of operation is known as a sleeve gastrectomy where a large portion of the stomach is removed.
"As in other parts of the health service, the quality of the care provided is not the issue: access to it is," he said.
The results of a drug trial in which he was principal investigator in Ireland were recently published in the 'Lancet' medical journal.
The drug, liraglutide 3.0 mg, may reduce diabetes risk by 80pc in people who are obese or have prediabetes.
The drug promotes weight loss by interacting with the areas of the brain that control appetite and energy intake.
Participants were also put on a reduced-calorie diet and a regime of increased physical activity.
Professor Carel le Roux from the UCD Diabetes Complications Research Centre, UCD School of Medicine and Fellow, UCD Conway Institute, who is an obesity specialist, was the lead global investigator and the corresponding author on this article.
The two specialists want the public portrayal and perception of obesity to change.
Prof le Roux said the notion that people can choose to be obese or non-obese has been shown to be no longer correct.
"We now know that obesity is a complex disease of the brain, and as a result it is the brain and not just the body which must be treated. It is unhelpful to suggest that all obese people should do 'is pull their socks up', 'push away from the table', 'suck on a carrot' or 'go for a run'," Prof le Roux said.
"Our Government must help the one in every 20 people who currently has diseases such as type 2 diabetes, sleep apnoea, subfertility, kidney failure or liver failure because of their obesity.
"The good news is that new treatments are available to help them, but funding and government policy must support not only prevention, but also treatment of obesity."
Dr Finucane agrees.
"It is essential we move away from negative stereotypes around obesity being a personal choice, a moral failure and a sign of weakness," he said.
"We could be doing more for prevention of obesity and we need treatment for those for whom the obesity time-bomb has already gone off."
Asked where he stands on the whole debate about the RTÉ programme 'Operation Transformation' which has just finished its latest run, he said he does not watch it.
"But I recognise how much good it does in raising awareness and the level of public interest in it could only be described as awesome," he said.
"In fairness too, it has evolved and improved with age. I worry though that it reinforces negative stereotypes. Worse, if it gives people the impression that the problem is being addressed by the Government, that is bad."