The crisis is already upon us and it will soon be our main healthcare issue. We all know the problem -obesity - yet Irish lifestyles suggest that dire warnings are going unheeded. Paul Cullen investigates
In hospital corridors and health charity offices around Dublin, a new campaign is being hatched, one that will make the campaign for a smoking ban look like child's play.
The war on junk food will be bitter and nasty and the outcome impossible to predict. Lining up on one side are health campaigners appalled at how our unhealthy diet is driving us towards obesity and illhealth. On the other are the Goliaths of the world food industry and their Irish allies, pleading the defence of consumer choice. And in the middle, caught between reams of medical evidence and the slick advertising of the food companies, are you and I.
"There's a big battle looming all right," says Michael O'Shea, chief executive of the Irish Heart Foundation, which funded much of the campaign in support of the smoking ban. "Tackling obesity may be more complex than fighting smoking, but the medical evidence is conclusive."
Voluntary regulation of the food industry isn't working and the Government "has its head in the sand," he claims, so legislation is needed to protect the consumer from unhealthy food.
Never has so much been heard about healthy eating, and health budgets are bigger than ever. The level of choice and information on food is unprecedented. Yet for all the pious talk, the statistics paint a starkly contrasting picture. There are now more overweight and obese people in the world than hungry people - more than one billion. Almost without noticing, Ireland too has put on the pounds; two out of every five adults are overweight, and one in five is obese. Some 300,000 of
our children are overweight or obese, and this figure is increasing by 10,000 each year.
Dr Tony O'Sullivan, chairman of the Diabetes Federation, follows the trail of the bulging waistbands when finding his way through foreign airports.
"If I'm heading for Dublin, I never need to look at the signs in the departure lounge," he says. "All I have to look out for is a bunch of fat people waiting for a plane and I know I'm in the right place."
O'Sullivan believes Ireland is sleepwalking itself into an obesity epidemic. "As a nation, we're doing nothing about it and, as a result, we will face major consequences in the years to come," he says.
Foodwise, we've never had it so good - and it is killing us. For every person killed on our roads, five people die prematurely of problems linked to obesity. The annual cost to the economy is estimated at €4 billion.
Obesity can cause a variety of health problems,including diabetes, stroke, gall-bladder disease, breathlessness and high blood pressure. Sufferers are also at greater risk of heart disease, osteoarthritis, gout and asthma, as well as breast and colon cancer, impaired fertility and back pain.
Dr Donal O'Shea, a consultant endocrinologist at the State's only adult weight-management clinic, in St
Colmcille's Hospital, Loughlinstown, Co Dublin, says he gets tired trotting out these figures only to see nothing happen. Since it opened in 2002, the clinic has been swamped with increasing numbers of obese patients desperately seeking help. Eighteen-year-olds weighing 18 stone and upwards are no longer an unusual occurrence. Twelve people, the youngest aged just 22, have died while on the waiting list.
These are extreme cases, but it's the constant "creep" in the nation's waistline that worries O'Shea. On average, he says, we've put on an extra half a kilogram a year for each of the last 20 years.
The body is a simple machine: food as fuel in, energy out. We consume about a million calories a
year and, hopefully, expend it all on living. Eat more, or exercise less, and the system goes out of whack. And once that happens, it can be very difficult to get back on course; the heavier we get, the less exercise we want to take, and the more likely we are to comfort eat or binge.
Many reasons are put forward to explain our bulging waistlines, from hereditary factors to a lack of exercise linked to our reliance on the car. Increasingly, however, health experts are focusing on food - bad food - as the main culprit.
O'Shea, for example, blames the "widespread and pervasive availability of unhealthy food in all areas of
our life" for Irish people's growing weight problems. "It's very difficult to correct the balance consciously," he says. "It has to be made happen for us, and the food industry needs to be majorly involved."
Our fondness for junk food, dense in energy but low in nutrients, lies at the root of the problem, says
Patrick Wall, a UCD scientist who is former head of the Food Safety Authority of Ireland (FSAI).
"We're clogging up our arteries and, worse still, our children's arteries," he says. "Food is fuel for the body;you wouldn't think of putting diesel in a petrol engine and you shouldn't put the wrong things into your own system."
O'Sullivan says our junk-food culture is pushing diabetes levels "through the roof", with people contracting type 2 diabetes at ever earlier ages. Half of all cases are attributable to being overweight or obese. Drugs help control the problem but sufferers face a lifetime of treatment and, ultimately, a multiplicity of complications including, in extreme cases, blindness and limb amputation.
IF THE MEDICAL evidence is so clear, why is so little being done about the problem? Last year's report of the National Taskforce on Obesity is already gathering dust, with few of its 80-plus recommendations implemented. Responsibility for the issue has been passedfrom the Department of the Taoiseach to the Department of Health and then to the Health Services Executive, which has been allocated a measly €3 million to implement the report.
Donal O'Shea acknowledges that the Department of Health has promised increased funding for the treatment of obesity but says there has been "zero coordination" between Government departments on tackling the crisis. A Department of Health spokesman assured The Irish Times that it was "developing a proposal for the establishment" of a Health Improvement Forum to co-ordinate health approaches across ministries.
"There seemed to be an appetite for doing things a few years ago, but now I worry about the influence of big business in the corridors of power," one health activist tells me. "The report from the taskforce was mild enough - they couldn't even bring themselves to refer to obesity as a disease."
The Government might be lackadaisical, but health campaigners have put issues such as food labelling,
curbs on advertising junk food to children and the promotion of an exercise-friendly environment on the
agenda.
Beyond listing the ingredients of a product, a manufacturer generally isn't required to provide much information on labels, unless specific claims are being made. Many voluntarily provide more information
but, accidentally or not, this tends to be confusing and technical. "We have to make sure food is safe and provided in a hygienic manner, but the rules have to allow small industry to operate efficiently," says Neil McGowan, of Food and Drink Industry Ireland. "We don't want less regulation, we want better regulation."
McGowan insists the key is not to mislead the consumer, yet in the same breath he concedes that there is a "grey area" between a manufacturer telling "the whole truth" and telling "their truth".
Dr Tony O'Sullivan, however, accuses the industry of deliberately misleading the public about its products. "Labels are confusing most of the time, and products are often advertised on the strength of a single chink of light," he says. "They'll tell us, for example, that an item is high in fibre without also saying that it is high in fat and sugar. Industry turns our health advice on its head and has a vested interest in suppressing the harmful effects of some of its products."
The messages put out by the €17-billion-a-year food industry go largely unopposed because the budget for health promotion is so small, according to O'Sullivan, "but in any case, what kind of health system can compete with constant food advertising on prime-time TV?".
McGowan says labelling has to be clear, relevant and easily viewable, but "you have to look at diet as a
whole and not just try to demonise particular foods". Food has too many exceptions to allow for strict rules on labelling. Most products - for example, olive oil or milk - have good and bad properties.
The industry knows that the regulations on labelling are going to get more stringent. In the US, manufacturers are required to list the amount of cholesterol and trans fats in their products. UK authorities have recommended a traffic-light system for food products, where the fat, salt and sugar components are indicated by a red, amber or green light on the packet. The FSAI, which has begun a consultation process, may head down the same route.
For the moment, labelling remains largely voluntary. Intense lobbying by the food industry has slowed
the rate of change, and it isn't open to individual EU states to bring in regulations that could be interpreted as barriers to trade.
Personal responsibility is the mantra of the food industry, which maintains that there is no such thing
as good or bad food, only bad diet. If consumers want to live healthily they should take more exercise, heed the advice that's out there and choose the healthy options provided by retailers.
Freda Molamphy, of Tesco Ireland, feels that blaming supermarkets for the declining quality of our diet
is misleading. "We offer a choice to the consumer, including a complete range of fresh food and organic
ranges," she says. "It's up to the consumers to decide. We only follow what they dictate."
The problem with leaving things to the consumer is that years of health education and dire warnings have
failed to make much of an impact on those most at risk. Surveys show that consumers are increasingly aware of the health message, yet follow-through is lacking. Resistance is hard to maintain when temptations abound and eating habits are set.
"People look for absolution for their lifestyles rather than changing what they do," says Dr Patrick
Wall. "They'd rather buy a product that claims to lower their cholesterol than take exercise."
SO WHY AREN'T we all up in arms about the dangers of bad diet? Wall cites the concept of "probability neglect", used by scientists to explain why people worry about low-probability catastrophes, such as air crashes, yet pay little heed to significant risk factors such as diet, even when we can influence these. We know bad diet can kill us; we just don't think it will happen today or tomorrow.
US activists claim consumers live in a "toxic food environment" where junk food is always present,
eating patterns are established from childhood and fresh produce is unavailable or expensive. There is evidence that while better-informed, better-off consumers are making healthier food choices, the poor are eating worse than ever, and paying the price in weight and health. According to Prof Cecily Kelleher, of UCD's Nutrition Surveillance Centre, supermarket chains offer a greater choice of healthy foods in branches in well-off areas than they do in poorer areas.
"Rich middle-class people have never had it better, and poor people have never had it worse," says celebrity chef Jamie Oliver, whose campaigns for healthy eating have had some effect in the UK. Ultimately, it may take legal action to force the rate of change.
For the moment, though, Irish people will keep on putting on those pounds. And, as one doctor told me: "If anything is going to break the arse of the health service, this is it."