Second Opinion: How can we stop Ireland’s unfair society contributing to obesity?

No one seems interested in the fact that poor people cannot afford to buy real food. Photograph: Getty Images

No one seems interested in the fact that poor people cannot afford to buy real food. Photograph: Getty Images

Wed, Feb 19, 2014, 09:00

The numbers of people with serious health problems such as cancer, obesity and diabetes are increasing at an alarming rate. A report from the Irish Longitudinal Study on Ageing (Tilda), The Over-50s in a Changing Ireland: Economic circumstances, health and wellbeing , published last month, shows 79 per cent of older adults are either overweight or obese.

More than half of older adults are at a substantially increased risk of metabolic diseases, such as diabetes, based on increased waist circumference.

Increased waist circumference is also associated with disabilities, leading to a vicious cycle of less activity, more weight and more disability.

Cancer Projections 2015-2040 , from the National Cancer Registry Ireland (NCRI), estimates the number of invasive cancer cases will increase by 84 per cent for females and 107 per cent for males by 2040.

The World Cancer Report 2014 published by the World Health Organization (WHO) concludes the spiralling costs of cancer treatment are damaging the economies of even the richest countries.

Activity in Acute Public Hospitals 2012 published by the ESRI in December 2013 shows more than 10,000 people were treated for type 2 diabetes during that year. Half of all cancers and 90 per cent of type 2 diabetes can be avoided by changing five lifestyle factors: reducing tobacco and alcohol consumption, increasing physical activity, eating healthily, and being a healthy weight.

Call for taxes
The WHO recommends taxes and advertising restrictions to control the availability of alcohol, sugary drinks, and cheap, energy-dense, nutrient-poor foods. Poor people are at least twice as likely to be obese and get cancer so fairer societies are also needed.

This evidence is not new. Health professionals have known about the importance of healthy lifestyles since at least the 1960s. The public are equally well informed about health matters.

At any one time at least half the adult population are either thinking about losing weight or are on a diet. Unfortunately, information does not change lifestyles, and behaviour experts have known this since the 1980s. They know that perceptions of health issues are influenced by personal experiences more powerful than any health education message, such as not having enough money to buy healthy food.

Regulatory and environmental changes are needed to make healthier choices easier choices, such as stairs being easier to find than lifts, alcohol not being sold in filling stations, and vending machines in schools selling nothing but water. Why is this not happening?

The response to the obesity epidemic by Government and the HSE has, to date, been woefully inadequate. There is a reluctance to introduce legislation and regulation to limit and control the availability of alcohol, sugary drinks, and cheap, energy-dense, nutrient-poor foods.

No one seems interested in the fact that poor people cannot afford to buy real food. Politicians make excuses as to why alcohol sports sponsorship cannot be banned right now.

When the reports were published no media commentator made the connection between inequality, obesity and cancer. The media, and in particular RTÉ, focused almost exclusively on individual lifestyles and personal responsibility.

No one bothered to analyse the conclusions of the WHO report in relation to taxation, legislation and regulation.

Unfair society
A recent Prime Time programme on childhood obesity had panellists of doctors and dietary experts. By the end of the programme, viewers were no wiser about how to prevent obesity in children.

Presenters, panellists and audience did not discuss taxation, legislation, regulation, and how Ireland’s unfair society contributes to childhood obesity.

No one represented the views of poorer people or mentioned health inequality. Operation Transformation , while entertaining, reinforces the idea that a healthy lifestyle is solely an individual responsibility and anyone who doesn’t have one is lazy, disorganised or irresponsible.

When the cancer reports were published, RTÉ News at One interviewed a doctor whose only advice was for everyone to know their Body Mass Index. Is this good enough?

While RTÉ is not responsible for improving health, that is the Government’s job, it is responsible for thoroughness, which includes analysing the links between poverty, an unequal society, obesity and cancer.

The Government must act now and introduce the necessary legislation and regulation, including fat and sugar taxes and banning the advertising of cheap, energy-dense, nutrient-poor foods and alcohol sports sponsorship. It would be nice to think politicians would act based on international best practice but unfortunately they are more likely to act quickly if public debate, generated by in-depth media analysis, is informed by international scientific evidence.

Dr Jacky Jones is a former HSE regional manager of health promotion.

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