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IRELAND HAS A problem with obesity.
That’s the consensus from the World Health Organisation, among others.
They say that, on current trends, 89% of Irish men will be overweight by 2030, and nearly half obese.
Public health interventions are certainly required, but a group of doctors say that if the government and HSE treated obesity as a disease of the brain, and offered expanded access to surgical treatments, then it could save the exchequer millions and help to alleviate the problems associated with it in Ireland.
John Conneely is a consultant surgeon at the Mater Private Hospital in Dublin. He told TheJournal.ie that it’s a “no-brainer” to offer surgery as an effective means of treating someone with obesity over a certain weight.
The Irish Society for Clinical Nutrition and Metabolism agrees and says that, by doing a minimum of 400 operations per year on patients with obesity and difficult-to-control diabetes, it would have saved the State €56 million over 10 years from a reduction in the costs associated with treating people with diabetes, and other obesity-related illnesses, over a long period.
Dr Helen Heneghan, alongside Conneely, are two of only six consultants in the country that offer this surgery. Having held a similar role at an NHS trust in Liverpool, she was recently selected to fill a specialist role in this field at St Vincent’s Hospital.
She told TheJournal.ie: “We do not have a national obesity programme in place at the moment… In Ireland, we do around one of these surgeries per 100,000 people per year. In the UK, its 20 in every 100,000. The US do 44. And Scandinavian countries do 78. Our need is as great as theirs is.
In 2005, specialist treatments were recommended then, but nothing happened. In 10 years, there’s a potential saving of €56 million if you take into account the cost of a diabetic regime which can be in excess of €4,000 per year. If we could have intervened earlier, and put diabetes into remission, we could have saved the cost of medications over that length of time, and more.
Doctors say that offering obesity surgery is the most successful and cost-effective option for the treatment of severe obesity and point to evidence that says 90% of patients who seek the procedure achieve more than 10% weight loss.
Research from Swedish researchers also suggests that patients with type-2 diabetes who undergo obesity surgery can achieve remission from their disease.
And research conducted in Ireland last year suggested that only around 0.01% of the patients who would benefit from obesity, or bariatric, surgery in Ireland have access to it.
If such surgery is so beneficial, and the number of people overweight in Ireland continues to rise, why is it not yet seen as a viable option?
Changing attitudes
Conneely said that, in Ireland, we don’t deal with issues around obesity in the best manner.
“It’s impossible not to be aware of obesity as a health issue these days,” he said. “We’re just not as active as we used to be. And we live in an era of enriched foods that are available 24/7.
But we don’t deal with it terribly well here. The notion you would perform surgery on overweight people is anathema. This is not a cosmetic thing, though. This is to arrest, or reverse, debilitating conditions associated with chronic excess weight.
Heneghan said that dismissing the idea of offering surgery to someone who is obese is the same as denying surgery to anyone with another type of disease:
This is the last acceptable form of discrimination left in society. People consider this a lifestyle choice. We fully believe, and we want to get across, that this is a disease. It is a disease of the brain and the way the gut talks to the brain.
She added that treatment for other chronic diseases is standard across the board and that there’s no reason why obesity should be considered differently.
Best way forward
On the treatment itself, Conneely said that the weight loss surgery programme on offer has been shown to cut a patient’s excess body weight in half within a year of the treatment.
The gold standard surgery comes in two forms – a gastric bypass or gastresctomy – and both are minimally invasive.
It is intended for patients with a BMI index of over 40 kg/m2, or for patients with underlying conditions such as type-2 diabetes with a BMI of over 35kg/m2.
For someone who is 6 foot tall, the 40kg/m2 BMI would equate to a body weight of 134kg, or 21 stone. The equivalent for someone who is 5’5″ would be 109kg, or 17 stone 2 pounds.
Conneely explained: “It’s laparoscopic – or keyhole – surgery and patients will typically be discharged and back on their feet after only a couple of days.
“A gastric bypass involves rerouting the small intestine… it changes how patients absorb their food and how hungry they feel. With a gastrectomy we remove a large portion of the stomach… which becomes a narrow tube that fills up quickly. People want to eat less and as a result lose weight.”
The two forms of procedure are now favoured over gastric band surgery, which both doctors agreed is not as successful in the long-term.
Heneghan said: “People have so much to gain from this type of surgery. Within 24 hours of bariatric surgery, type-2 diabetes will be essentially cured. There’s huge cost savings to be made from it.”
“Surgery is the form of treatment that works most successfully,” Conneely said. “Most people who get this surgery will have already tried dieting, or fat-lowering and appetite-modifying medication.
The truth is we don’t provide a service in any effective way for this. This is a major medical condition for which there is incredibly effective surgery.
“I’m a different person”
Rachel* (not her real name) is a young woman who had been overweight since she was a child.
Treatments from her GP, working with a personal trainer and strictly following diets had not helped her to lose weight, and she felt it held her back from doing things she wanted to, to a certain extent.
She told TheJournal.ie: “I don’t have diabetes, or high cholesterol, but my GP told me there was no doubt I’d have these problems and possibly others within the next few years.”
Her GP had attended a seminar where Conneely gave a talk and, from there, made contact to explore the possibility of undergoing bariatric surgery.
“My family could see that no matter what happened, I gained weight,” she said. “I needed to do something for the good of my health”.
After meetings with a doctor, dietitian and a psychiatrist, Rachel was deemed suitable for treatment and the gastric sleeve (gastrectomy) was performed at the beginning of this year.
The immediate aftermath of the surgery was painful, but it soon paved the way for a dramatic weight loss.
“It’s major abdominal surgery,” she said. “The only day I regretted getting it done was the second day, because I was in a lot of pain. I got excellent treatment from the staff who helped me along.
It was amazing how quick the effect took place. I’ve lost three stone in just a couple of months, and that’s weight that will stay off.
Since the surgery, Rachel feels her quality of life has greatly improved. “My energy levels have shot up, and I have the drive to go out there and do things I was unwilling to do before,” she said.
She also rejected the idea that getting this surgery was an “easy way out”:
Being overweight is taboo in Ireland. There’s a stigma attached to it. But I’ve gotten this surgery and it’s going to help me so much in the long-term. It’s not an easy way out. You still have to work hard at it by eating well and doing exercise.
Funding
Heneghan added that securing funding for these surgeries is an ongoing issue that has persisted for years.
“There is a programme in Dublin and in Galway but it is so under-resourced,” she said. “We don’t want to be fighting for beds with other patients. We want them ring-fenced for these patients and have it prioritised like other ill patients.”
While additional funding has been forthcoming in recent years, a great deal more will be required to be able to offer these surgeries on a national basis.
A national obesity programme is essential, said the doctors, with personalised treatment a prerequisite going forward.
With the next generation of Irish people having a potentially lower life expectancy than their parents, in part due to the associated problems around obesity, its future cost to the state should be an urgent priority according to these doctors.
Conneely added: “We’re building a good system here. What little services are available are of high quality.
We just need a lot more of it. And we need it now before it’s too late.
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We need to massively cut down on the amount of sugar we consume and we need to support people in doing this.
It disappoints me when any positive endeavour get criticised as nanny state.
My kids secondary school has vending machines dispensing confectionary and sugary drinks, on every floor.
That is wrong.
I do my best but I expect my government to support me.
Let me send my kid to school without mars bars in his face everytime he walks out of the classroom.
@Tom Burke: recently I was in Spa
@john Appleseed: we should replace all religion classes in schools with something useful like a health class that cover the entire range of health issues. From nutrition. To exercise, to mental health. I would be probably out of a job but at least our obesity epidemic would be under control. If you struggle with your health… Well cheeky plug! http://www.bodycoach.ie
@Tom Burke: Perhaps not allow kids to bring money to school might help solve the problem, therefore removing the temptation of buying fizzy drinks and mars bars.
@Michael Bodycoach: PE classes should live up to their name, physical education, however it is too focused on just playing games than being educational. It should also have exams as any other subject. That would encourage kids to improve their health and have the tools to maintain it.
@Michael Bodycoach: You speak, common sense and it’s a very hard thing to find here. Having PE classes, is not enough and they need to learn about the foods they eat. How to cook, what to avoid and Yoga should be included. At least, they’d have the tools and motivation to fight this problem. Get Religion out of schools, teach them the stuff they need and praying won’t make it happen. I’ve lost 10kg in last 8 months, no effort and a little education.
@Michael Bodycoach: Does Joe Wicks know about this?? :P
@Rob Cahill: he should no, nothing but a scam artist
More tought should go into preventative medicine and dental care in Ireland.
@Elizabeth Hourihane: Explains… http://www.thejournal.ie/sitdown-sunday-may-3389948-May2017/ lol.
@Elizabeth Hourihane: there’s no dental care in this country . people simply just can’t afford it .. the prices for some treatment is more than the average wage for a person and there’s no real help available. .unless you have a medical card .
@Suzie Sunshine: Agreed. It’s a brilliant way to make people unemployable. Why any government would want that is anyone’s guess.
I think they left out an important part of this article. . The price . How much does these procedures cost ?
@Suzie Sunshine: well the article focused on the treatments of obesity becoming more widespread and available to the general public, which would hopefully decrease the price of bariatric surgeries.
@Suzie Sunshine: less than the ongoing medical interventions with out it. Diabetes, Cancer ( being overweight is an increased risk factor), heart attack, stroke risk increased!
@Suzie Sunshine: I’d say it’s less than the life long treatment of diabetes and other chronic illnesses this could prevent
Whatever happened to the idea of consuming less and exercise more. If it’s actually done properly the concept works but of course laziness in the problem in the first place with a lot of obese people.
@mickmc: Herein the stigma lies, Mick if you look into the world of gut microbiota you will see that for some this idyllic cure of diet and exercise may not be as you had imagined. We are becoming an obese nation and if people keep these kinds of comments, we will stay like that. This article is outlining the most effective ways of treating this epidemic, after years of research, yet people still believe it is solely because of laziness that 90% of men will be overweight in 2030. Unless we as a nation change our perception towards obesity and type 2 diabetes and treat it for what it is, our health service won’t be able to recover.
@Jack M: Well said Jack. But unfortunately almost no one would agree with that. If it really was as simple as “diet and exercise” there would be hardly any fat people!
@Jack M: So are you tell me we don’t lead more seditary lifestyles than we did 50/yesrs ago. We don’t consume more calories than we did 50 years ago when a fat person was a very rare sight. A small percentage of obesity might be cause by medical problem but the vast majority is self inflicted.
@Rui Firmino: It is as simple as diet and exercise though. Fat is literally just excess energy that the body has stored. Unless you’re suggesting that there are some people out there who are capable of producing fat out of nothing, (and therefore violating the laws of thermodynamics in the process), then taking in less calories and burning off more is the solution. Yes, some people will find it harder than others, but ultimately, it just means that it requires more effort on their part.
@Methodical Insanity: Studies have found that in the long term it is virtually impossible to lose weight. http://www.cbc.ca/news/health/obesity-research-confirms-long-term-weight-loss-almost-impossible-1.2663585
@Rui Firmino: That study is complete crap. The reason why so many obese people end up putting weight back on after having lost it successfully, is because once they lose the weight, they go back to their old bad habits instead of sticking with the diet and exercise routine that helped them lose the weight. Of course they’re going to put the weight back on if they go back to the old habits that made them obese in the first place. The change in diet and exercise needs to be permanent in order to have a permanent effect.
This could be greatly improved in the span of a generation. Draft legislation that punishes parents who allow their children to become obese. Call it for what it is, child abuse. Prevention is the best cure in the long term.
Sean really nice article. I think the comments are going to be overwhelmingly negative though. For those of you talking about preventative medicine, sure that the number 1 goal but when that fails it looks like medium/long term that surgery is the answer. Its cost effect after 5 years and gives the person who receives it a much better standard of life. The cost is about 15000euros currently but, if you take into account cost to the health service monitoring, sick leave of the patient, other illness that happen because of being overweight/diabetic this is cost negative after 4-5 years. Its the same thing with smoking, it costs more short term for the hospital to give us free nicotine patches, but long term it saves a lot of money. I used to work in this field as a research scientist.
I think we first need to address the free for all landscape that is dominated by highly processed, high sugar, high fat and low nutrition food that is endemic in our lives today. People need to be protected from these food like products that are dominating our supermarket shelves. Most people don’t understand their role in obesity and their ability to create a false appetite. The soda tax is only the tip of the iceberg and we can see already the political reluctance to deal with this. This is central to the problem, trying to balance the health impacts of these foods with corporate interests. We saw where this led us with tobacco and how long it took t take a tough stance on it, particularly when it comes to targeting children. However, it needs to go much further. We need to educate our children in school about food and nutrition and teach them how to cook as it is a critical life skill and much more important than other items filling the curriculum. Then, and only then, will they be able to make informed decisions about what they put in their mouths and will understand the consequences. Saying that people are not as active as previously has been proven to be a red herring of sorts and it has been shown time and time again that no amount of physical activity can work off a diet as calorie dense as the foods that are currently marketed, particularly to children. Be in no doubt, this advertising is very slick and some of these foods are developed to be as addictive as possible. People really stand no chance in this environment. It’s a David and Goliath scenario and public health is the evidence of this. The surgery angle shows our failure to meaningfully tackle the root causes and to show a bit of leadership.
I found that I gained weight easily after my third child. Before that I could eat anything and not put on an ounce. Twice I’ve tipped the scales at 12 stone. And both times I’ve said enough and gone on a diet. The first was exercise and smaller portions. Though after 2 years I was back from 10 stone 5 to 12 stone though I had not gone up a dress size.
The second diet I’m on now, it high fat, low protein and even lower carbs. Little exercise. In 7 weeks I’m back to 10.5 stone. And still losing weight, though I’m starting to increase my fruit intake. I’m a big 12, small 14.
I look for foods in high fat, I add cream to everything, though I’m getting sick of rashers and butter and the thought of olive oil makes me want to yack.
I’m hoping to lose another stone. My pre pregnancy weight.
Surprised not to see any reference to education? Surely there is a long way to go before reaching a weight level where surgery is necessary? There are a lot of “plump” (is that word allowed?) children and adults around who are getting bigger but could still control their food consumption if they had the basic learning tools. I also agree with a previous comment about vending machines in schools as well as a personal vendetta against sweets at check outs
Being fat is not a disease . it’s actually insulting to people with genuine eating disorders.
@Dj: I really don’t see the difference in starving yourself to death and eating yourself to death. Both activities that a healthy mind would engage in.
@john Appleseed: would not engage in!
@Dj: I see it as a mental problem, people know what they should be eating and that they should be exercising every day, yet they don’t conform to it.
Weak minds.
Fast fix nation. No doubt the private doctors wanting the state to bankroll their profits want their business to be funded by the taxpayer – I”d much rather PE be brought into schools on a daily basis for each child, state funded gyms to be put into communities that stay open after 9pm at night & a legislated solution to the working practices that have people enslaved at their desks and away from their homes in work and commutes often from 7pm -7pm each day – hardly conducive to good eating habits.
@Helen Ryan Come on, people have really lost all trust in professionals these days have they, everything is profit-based. Helen, have you looked at the statistics, the problem is here, prevention (although extremely important) is not the primary issue. As the article states, any person with type 2 diabetes or who is obese costs the government millions each year and with 90% of men to be overweight by 2030 this is an issue for right now and for our government not private doctors. But, of course any possible medically-proven preventative surgery has to be a profiteering scheme by private doctors to con the tax payer.
Hands up who else first misread the headline as “Is sugary the way to help solve Irelands obesity crisis?”
I do wonder if a well known herbicide adds to this as it was reported recently a man cured himself of diabetes by cutting out bread and pasta in his diet…
@Alois Irlmaier: step away from the daily mail Jesus I’d believe Tinky Winky before anything quoted as fact in that rag – like seriously it’s a comic for adults with low expectations!
Surgery is not the answer to obesity, no more than a smoker having his lungs removed.
@Chris Kirk: Chris I implore you to look into the successes of surgeries like the Roux-en-Y, this is the answer and please do some research into the topic before commenting such horse sh*t
i’m off to weight watchers!
The problem won’t go away. Here is a (partial) solution. Much like alcoholism, you can’t just order people to change their behaviour. Unlike alcoholism, a surgery can do significant damage and cost reduction.
Who writes this crap?.
@Francid Dooley: Sean Murray apparently
@Francid Dooley: This ‘crap’ is the prevention of the worlds fastest growing epidemic. But, i’m guessing you are another believer in diet and exercise always being the answer. Let’s see where that leaves the HSE in 20 years time
Surgery is not the way forward, I underwent an emergency midline laparotomy procedure in 2011 and still trying to recover. For the past nearly seventy days now, am off all cakes, bread, potatoes, biscuits, sweets, minerals, sugar, tea, coffee, alcohol, pepper, salt, deserts, have full milk with porridge or weetabix, no sugar, a boiled egg or two, no salt, mid morning maybe a cup of homemade soup, no bread, eat a full dinner, no potatoes, fresh fruit, apples mostly, occasionally banana, yoghurt, fresh raw lettuce, iceberg, celery, tomatoes, tuna in sunflower oil, when I can afford to go to supermarket, living in a homeless shelter makes it easier, I don’t have much spare cash, pay one hundred and fifty euro to management weekly for my keep, includes all meals, cooking, cleaning, washing, laundry, utilities, I don’t get weekly fuel allowance or monthly household benefits package. I intentionally have not weighed myself, hope to continue with my plan, not under any medical supervision, however my doctor is aware of my initiative. I find daily tasks like going to use the bathroom easier, I need to clean myself by lying on the bed, I am unable to clean myself standing up. I need to use a plastic jug for the wee wees, since my operation to attempt to correct and repair a para umbilical hernia, severe and acute with an extremely large mass. I feel lighter and a little looser, my clothing fits better. I shall continue indefinitely, every day is a challenge, I do not feel deprived or hungry. The way forward is self education based on self experience. Bariatric surgery only causes long term problems, it is a quick fix, money making racket, the long term lasting and permanent solution to my morbid obesity is literally in my own hands, we need to stop advertising high fat, high sugar products, we need to educate our young at pre school and primary age, by the time they get to secondary level it is too late. Please copy, share, post, thank you.
@Michael O’Riordan: An interesting story and I hope you keep up the good work, am interested though in your reasons for not weighing yourself, as what is not measured is not manageable. I would imagine that for serious health implications, keeping a careful accurate monitor on it would be important, as the feeling of how your clothing fits could be subjective day to day and not a quantified number, if you get my drift?
Just go on a diet fattys
Research suggests that if trends continue 152% of Irish people will be morbidly obese by the year 2050.
These people don’t take into account the laws of demonising returns. Typo intended.
How about not giving massive subsidies to the meat and dairy industries and subsidising fruit and vegetables instead?
Article is nothing more than a cynical advert by surgeons.
Obesity can be solved when people realise there’s a relationship between what goes in the mouth, and weight.
And that won’t suit the processed food manufacturers…
US to ban Trans Fats from 2018 .. Denmark banned them in 2006!
US consumption of trans fats is 2.2 kg or 4.6 lbs per person per annum!!!
A ban on Trans fats in your diet can completely reverse Diabetes Type 2 in some people. Trans fats are artificial fats which prolong food shelf life ..but shorten your’s. Insulin expects to find natural fats (not artificial trans fats) on the outer cell membrane to activate the insulin receptors and trigger the internal cell process to consume sugar in the blood. Trans fats are a different molecular structure and have an additional hydrogen atom which seems to inhibit insulin function leading to Diabetes T2.
Trans fats may also be root cause of obesity and root cause of incorrect cleave of amyloid protein in the brain cell membrane which leads to build up of plaque (toxic fragments) which leads to Alzheimers Disease.
Tackle root cause before considering radical surgery.
Education is the key. It baffles me that a person has to study for 4 years to be a Physical Education Teacher and it’s not an official subject in any state exams for secondary school. Can’t see why a curriculum can’t be designed to tackle a healthy lifestyle. Ludicrous…
Education costs the taxpayer but does it work? I know plenty of smokers who continue to smoke after they’ve been educated?
have your say