One in four Irish people is obese, according to a recent survey - but who decides what constitutes being overweight and what can we do about it, asks Fiona McCann
ACCORDING TO THE Miriam Webster online dictionary, it's "a condition characterised by the excessive accumulation and storage of fat in the body". The medical definition is "BMI (body mass index, a figure calculated using a person's height and weight) of or above 30". The word in question is "obese", which conjures up pictures of bed-bound Americans who have to be airlifted out of their houses when their hearts give in, not something that affects ourselves.
But look around you: if the results of the Slán 2007, a national survey of health and lifestyles in Ireland, are to be believed, one in every four people is obese.
The point, apparently, is not aesthetic. That we're a nation of cuddlies coming in all shapes and sizes is not in itself a negative thing; that we're a nation of walking time-bombs, where normal weight is the new abnormal (only one-third of those surveyed weighed within the so-called "normal" range, indicating a BMI of between 18.5 and 24.9) is the issue.
Because the same objections to underweight models and anorexic stars can equally be applied to overweight friends, parents, children or, let's face it, ourselves. It's not about conforming to one particular body shape - it's about staying alive.
We all know that obesity is bad for your health, but we may not agree with how it is calculated. Take the BMI: apparently, George Clooney's BMI has him hovering on obese, and Lord knows he is not an unhealthy specimen. Can we even trust it as a gauge, given that it doesn't take into account muscle mass, and that according to this measurement most of the Irish rugby team would be candidates for obesity?
"The Body Mass Index is a very good population measure for obesity and it's what the World Health Organisation uses," argues Dr Donal O'Shea, associate professor of medicine at UCD and consultant endocrinologist in St Vincent's hospital, Dublin, who also runs an obesity clinic at Dublin's Loughlinstown hospital. "We don't have an epidemic of elite athletes in this country,"
Even if we do accept that we're a little on the portly side, is all this scaremongering taking the obsession with our expanding waists a little too far? "The medical complications of obesity are very real," says O'Shea. "We know that a Body Mass Index of 30 increases your risk of getting certain types of cancer, increases your risk of getting dementia in later life, increases your risk of getting diabetes, and there isn't really any hiding from that. They are established medical facts, and there seems to be a reluctance in people to apply that to themselves."
Given the amount of information available today in terms of optimum calorie intake, food calorie content, exercise machines which clock every calorie, and all manner of diet products on the shelves, do we really have any excuse for obesity? "There is absolutely no doubt that individual responsibility is a huge factor," says O'Shea. "The final decision about what you eat yourself is yours."
O'SHEA ALSO SAYS we must take a collective responsibility for the problem. "The only things that have worked in other countries [when it comes to combating obesity] are when there's been a collective approach, pricing policies, education, health promotion campaigns. Then you can turn around people's eating habits, you can reduce their obesity rates, but it has to be coordinated and it needs to be structured." According to O'Shea, the impetus to tackle this growing problem must come from the Taoiseach's office. He has said this before, as a former member of the National Taskforce on Obesity which published 93 recommendations to tackle the issue three years ago. They included a call for the Taoiseach's office to take "the lead responsibility and provide an integrated and consistent proactive approach to addressing overweight and obesity".
Dr John O'Riordan, the Irish College of General Practioners' representative on the Taskforce and co-founder of GP NOW (National Organisation for Weight Control), says that while a small percentage of the recommendations have been introduced, a large majority have thus far been ignored.
"From a broader point of view, very little has happened," he says, adding that such inaction not only take its toll on our health, but on our pockets too. "The failure to do anything is completely short-sighted, even from a purely economic point of view," says O'Riordan, who cites growing numbers of people suffering from diabetes as one of the obvious consequences of our growth in size. "The economic cost to the country has been calculated, and it's in billions. For some investment now, you'd save huge amounts of money in the long term."
The Taoiseach's office, while inevitably directing queries regarding their plans to tackle obesity to the Department of Health, did make it clear that "this Department will facilitate the Minister of State in the implementation of her plans, including any assistance needed with cross-departmental arrangements". The Department also points to the HSE's five-year plan which it says includes a number of initiatives to tackle obesity.
However, O'Riordan believes the issue goes beyond the health remit. "Everything that's being done by Government should be with regard to its effect on our weight levels," he says. This includes providing cycle lanes, play areas and examining fast food advertising.
ALL THESE CALLS for actions are well and good, but in the meantime, it's just you and your weight problems. According to nutritionist and dietician Margot Brennan, a member of the Irish Nutrition and Dietetic Institute, it's little wonder the country has a weight problem.
She says overweight and obesity is a normal response to the current environment we're living in, where food is available and where exercise is being reduced, whether it's planned exercise or even just domestic chores around the house. "The quantity of food, the portion sizes, all of those things go against being healthy," says Brennan.
There is also the genetic factor. Though health experts may be reluctant to allow people to cite genetic make-up as an excuse for excess weight, it does go some way towards explaining why some can appear to eat all around them without adding an inch, while others expand at the mere sight of a custard slice.
"There's an awful lot of research going on into hormones, and the chemicals released around the stomach, and there are certain people whose fat cells seem to make them gain weight easier," admits O'Riordain. "There are certain people for whom it goes on quicker. Genetics is certainly being increasingly recognised, but we still have a problem that needs to be dealt with."
But if our genetic codes have the odds stacked against us, and we live in a time-poor, desk-tied environment making exercise difficult, what are we supposed to do?
"First off is to know your own weight and Body Mass Index," says Brennan. Though the Taoiseach declined to provide his BMI when requested, individuals are encouraged to calculate their own, as well as to monitor their waist circumference. If the numbers add up to overweight or obese, then its time to take action - by starting to eat a proper breakfast.
"The most important dietary change would be have a breakfast," says Brennan. "Then eat more fruit and vegetables. It's not about making huge changes, but instead of having a biscuit with your coffee, try and put an extra piece of fruit between meals."
If all that fails, there's still one recourse - vote. "The time for reporting is over and the time for doing something is here," says O'Shea. "Whenever the next elections come up, they should be fought on an obesity ticket."
VITAL STATISTICS
23
Percentage of Irish adults who are obese
80
Percentage of Irish men over 45 who are overweight or obese
71
Percentage of Irish women over 45 who are overweight or obese
57
Percentage of Irish men aged between 18 and 44 who are overweight or obese
41
Percentage of Irish women aged between 18 and 44 who are overweight or obese
35
Recommended percentage of energy intake from fat
58
Percentage of Irish adults with a fat intake of over 35 per cent