Fat nation: Is Ireland eating itself to death?
Ireland has been caught in a perfect storm of poor diet and sedentary lifestyle... and it threatens to turn us into the fattest country in Europe. Are we eating ourselves to death?
To doctors like Donal O'Shea, it is the race we don't want to win. The latest figures from medical journal The Lancet show that Irish males are on course to become the fattest men in Europe within the next decade.
The report finds that Irish women are also breaking the scales as they head towards the top of the heavyweight table.
Already, one in four Irish children is classified as "overweight or obese".
Another report this week showed that the number of young people taking part in any sport at all in a six-month period has dropped to 68pc.
So, how did we find ourselves in this position?
"Back in the 1950s, we were the leanest people in Europe. If anything, at that time were too thin," says Dr O'Shea, Director of the Weight Management Clinic at Dublin's St Columcille's Hospital.
Since the 1970s, we have had a transformation in our lifestyles, and are now facing a potentially life-threatening battle of the bulge.
Despite no end of advice, nannyish healthy-eating tips from nutrition watchdogs, food pyramids, countless reports from health quangos and TV shows like Operation Transformation, we seem to be losing the war on weight.
According to the Lancet report, by 2025, 38pc of men and 37pc of women in Ireland will be obese. And six out of 10 adults are already classified as overweight.
"Just giving advice does not seem to have worked. The average Irish adult is one or two stone heavier than they were 30 years ago," Dr O'Shea tells Review.
While this trend is common across the world, it is not universal. Women in Singapore, Japan, Belgium, France and Switzerland have hardly increased their body mass index over the past 40 years.
A coincidence of two changes in our lifestyle helped to bring about the great expansion in the national girth.
"We changed to a diet that was high in fat, high in salt and high in sugar, and the number of fast food outlets grew," says Dr O'Shea. "At the very same time, physical activity started decreasing. These two factors - changing diet and growing inactivity - came together in a rush, and obesity took off and it keeps going up."
Our grandparents may have had a lower life expectancy, but their unprocessed diet of meat, potatoes and veg - the 'holy trinity' - had health benefits.
"There is a lot to be said for your traditional dinner," says Janis Morrissey, dietitian at the Irish Heart Foundation. "Jobs in our grandparents' time were also more manual, and that made a lot of difference."
Some of the causes of our great expansion may be obvious. The popularity of television, the growth in the number of cars, and the decline of manual labour in favour of office jobs, all mean that less physical activity is required to get by.
In 1981, half of all children in Ireland walked to school. Now, that figure is 25pc.
In other countries, the acknowledgement that we lead more sedentary lifestyles is accompanied by more organised physical activities, particularly for young people. Streets are designed to encourage us to walk or cycle.
"Children should be getting one hour of physical activity a day in school. At second-level, students are supposed to have two hours of PE in Irish schools in a week, but many don't have any at all," says Elaine Mullan, lecturer in health-related social sciences at Waterford Institute of Technology.
Many secondary schools have no gym and no playing pitches.
Some of the changes to our lifestyle have happened without us even noticing.
The Irish Heart Foundation's Morrissey says portion sizes for some foods have grown spectacularly. A survey by Safefood Ireland has shown that the average jam doughnut is three times bigger than the equivalent in the late 1990s. The same goes for croissants and fruit scones. The average muffin and Danish pastry is four times bigger. Did we even notice?
Small and almost imperceptible changes to our lifestyle make a difference to our level of physical activity, and these all add up.
When driving, we used to have to roll the window down manually - now we just press a button. To change channels we had to walk to the TV set and possibly argue over who would do it; and 40 years ago dishes were more commonly washed and dried by hand, requiring a greater expenditure of energy.
The digital age has only added to this surge in inactivity.
Office workers send emails to colleagues who are only a few feet away or down the corridor instead of walking over to them, while kids are more likely to play games on computers than out on the street.
Amid growing safety fears, particularly about traffic, children are given less freedom to roam, and may even be barred from running in school playgrounds. A recent report on obesity by the Royal College of Physicians of Ireland advised that schools should allow "running and free play" in school playgrounds and recreation areas.
Unlike other physical conditions, obesity tends to be regarded as a moral failing, and there is an attitude that it comes about as a result of some sort of gluttony and sloth. But is the preaching tone of so much of the health advice given out counter-productive?
According to Francis Finucane, consultant endocrinologist at Galway University Hospital, making the obese feel ashamed is the wrong approach.
"Rather than seeing it as a moral flaw, we should see it as a complex disorder. The reason there are variations in who is fat and who is thin is largely down to genetics.
"Behaviour to do with physical activity and diet are to some extent beyond our control."
Dr Finucane believes that we can tackle the obesity epidemic by making changes to our environment and introducing taxes on fast food and sugar-sweetened drinks.
As a significant first step in the war on obesity, a tax on sweet fizzy drinks is now looking more likely after a number of parties included it in their election manifestos.
Some 15pc of people consume sweet fizzy drinks every day, but consumption rates are much higher in the 15-24 age bracket. Some 29pc of young men drink these high-sugar drinks daily.
When you look at the sugar content of some of these drinks, it is not hard to see why doctors are concerned. A typical small bottle of cola, for example, contains the equivalent of 12.5 teaspoons of sugar - and a 500ml energy drink can contain up to 21.5 teaspoons of sugar.
Advocates of such taxes believe that the example of the plastic-bag levy show how this type of measure can affect behaviour.
The Irish Heart Foundation commissioned research from an economist, and found a 20pc sugar tax would reduce consumption by 18pc, and would yield about €44.5m in revenue.
Waterford IT lecturer Mullan believes we need to change our transport policies to compensate for our sedentary lifestyles by encouraging more cycling and walking to schools and workplaces. Realistically, it may be impossible to drag school parents or workers out of their cars if they live far away, but measures can be taken to alleviate this.
"We can't expect everybody to walk or cycle all the way to school or work. But it's normal in other countries to have large park-and-ride facilities where there is room for bike storage," says Mullan.
At lunchtime in urban Ireland, it is common to see children in school uniforms queuing for fast food at nearby outlets, but there are now signs of a strong backlash.
In Greystones, Co Wicklow, parents mounted an effective campaign to create a "no fry zone" as they tried to stop a McDonald's opening near three schools. Although planning authorities approved the plans for the fast-food restaurant, the opening was stopped when the owner of the property, Lidl, decided it would use the site for other purposes. One of the local residents behind the campaign in Greystones, Philip Moyles, says: "We have been encouraging people to make submissions to Wicklow County Council's development plan to ensure that no fast-food restaurants can open within 400 metres of schools. There have been over 210 submissions from the public.
"One of the reasons for the campaign is to minimise the exposure of children to obesity, because this can carry into adulthood."
We may wring our hands at the preponderance of fast food and unhealthy processed products, but studies have found that the ingredients for a healthy diet can be much more expensive. The foods that make us obese, such as processed fatty meats, are often cheaper, according to Mullan.
It is no surprise, therefore, that social background is an important factor in obesity, particularly in childhood. Children growing up in low-income homes are twice as likely to become obese than those in better-off families, a Safefood study has found.
Unless urgent action is taken to prevent obesity, it may soon become normal, just as it is in the US.
"Our perception of normal body weight is determined by the people around us," says Mullan.
"If people around us are getting larger and larger, then our concept of what is normal changes - and we are more likely to be obese ourselves."