According to the World Health Organisation, incidences of obesity have tripled since 1975. In fact, the WHO declared obesity an epidemic back in 1997. Since then, the number of people with obesity has continued to rise, year after year.
Globally, 13% of adults are obese, and Ireland fares badly in comparison to our European counterparts with the ninth highest rate of adults with obesity – 25% – out of 53 European countries.
A stark WHO report, published last year, revealed that no European country is on track to stop the rise of obesity by 2025.
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Those living with obesity are more likely to develop serious health conditions such as type 2 diabetes, cardiovascular disease, cancer, stroke, high blood pressure, cholesterol issues, osteoarthritis, sleep apnoea and breathing problems.
There are new drugs to treat obesity, such as Semaglutide, also known as Ozempic (for diabetes) and Wegovy (for obesity). The former prompts the body to produce more insulin, which reduces blood sugar. The latter also acts to suppress appetite.
However, we have a long way to go before these drugs are readily available to every person who needs them, plus experts agree that prevention is better than cure. What is causing this rise in obesity, and what role do individual diet and environmental factors play?
Dr Margaret Steele, a postdoctoral researcher in UCC's School of Public Health, studies the best way to treat diseases on a societal and public policy level.
She says the way we understand and talk about obesity affects the way we treat and prevent it, and she recently completed research which recommended changing the name of the condition.
Currently, obesity can refer to a BMI category of 30 or more, but it is also referred to as a disease which has a number of associated health conditions. Dr Steele says is it possible for people to be heavier, but not have a lot of the health problems associated with being obese.
“The issue is not really about body size,” she adds. “The issue is the kinds of foods we are eating, our diet, the food environment we are in, and the way that messes up people’s metabolism.”
Dr Steele also says losing weight is not as simple as calories in and calories out. “Being on a diet is closer to holding your breath. Your body will be hungry while on a diet. It is very difficult to maintain without support. It’s nothing to do with willpower or moral fibre.
“If the basic physiology is out of whack, which is the case for people with the disease of obesity, willpower alone cannot fix this.”
While drugs such as Semaglutide will help, they are not a quick-fix, as the effects of the medicine wear off as soon as it’s stopped. People also need to maintain a healthy diet and exercise while on and off these drugs.
According to Dr Steele, it is not enough to just tell people to eat healthy. She continues, “In public health, the research is becoming clearer and clearer. With regards to things like gambling, smoking, and now obesity… just telling people that these things are harmful and expecting them to just stop doesn’t work. The reason why people engage in these behaviours is because of their environment.”
Things like socioeconomic status, the amount of time people have, their income, stress levels and home environment all factor in. “Of course there is a role for individual choice, but our choices are shaped by our environment more than previously acknowledged,” says Dr Steele.
In the late 20th century, people’s BMIs rose dramatically in Western countries. “This was the first time in history these people had enough to eat for a long time. Food became easier to come by,” Dr Steele admits.
The food industry managed to increase food production while simultaneously making their products cheaper. However, there were downsides to this. “In the US they planted tonnes of corn, to feed people efficiently. This worked well, but then it gave rise to by-products like high-fructose corn syrup,” says Dr Steele. “They started putting high fructose corn syrup in everything, because it was cheap.”
Nowadays, we are also bombarded with advertisements for junk food, and we can’t go into a shop without being shown hundreds of different high-calorie treats on offer. This was not the case 40 years ago.
We need to change the way we treat obesity, according to Dr Steele. At the moment, the health service assumes people can manage the condition by themselves if they try. “This isn’t really true,” she adds.
“The big role for government is prevention. That is around things like the sugar tax and limiting the amount of fast food outlets that open near schools. This would prevent young people growing up with a constant supply of cheap food that is tough to resist.
“The food industry often presents itself as being the one giving choice, but if you go to the shop and there’s only processed options or deli counter stuff, and it is difficult to put a healthy lunch together on the go, then that’s not a choice.”
Ultimately, the Government can’t police people’s behaviour, but it can give people better options, she says.
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