Good grief Northern Ireland you’re getting bigger! One-in-four of us has now moved up the scales to possess a “Over-30-BMI-Body”. Given that the expansion of the Ulster waist-line is threatening to bankrupt the Health Service in 20 years, obesity should be weighing heavily on the Health Minister’s mind; if only we had one. If we had, he or she should recognise the seriousness of the issue and scrap our Obesity Strategy (Fitter Futures for All: Framework for Preventing and Addressing Overweight and Obesity in N. Ireland).
Published in February 2012, revised in 2015, I had cause to re-read it recently and was appalled at how naive it is. Health minister Poots, then in post, should have aborted its publication and sent the civil servants responsible to bed without any supper for producing what must be the most; boring, dull, predictable and thoroughly useless document I have ever read. OK, I might be a little harsh here; the strategy has targets and I like targets; a 4% reduction in adult obesity and a 3% reduction in childhood obesity by 2022. But given the strategy’s emphasis and focus; he had only a slim chance of stopping a current annual rise. Five years and three health ministers on we are going the wrong way.
The strategy demonstrates a profound ignorance of the causes of obesity and as a consequence government remains in denial of the tsumani of adipose tissue currently swamping us. But remember DUP had the Assembly health portfolio back then and conservative thinking was dominant; blame fat people for being fat! We read again and again that people “must take responsibility for their own health”. Indeed, the aim of the strategy is “to empower the population of NI to make healthy choices…”. If this is all we can come up with we really are in trouble. If there were a simple relationship between calories in and calories out then how the hell did we get into this shape given that we are probably eating fewer calories now than we did 20 years ago.
A strategy that is solely focused on stopping thin people becoming fat by asking them to eat sensibly and take more exercise is just simply useless in the extreme. This only amounts to 25% of the problem. The remaining 75% percent is mostly beyond the control of the individual; 25% is down to genes, 15% down to poor food labelling, 15% down to processed foods and 20% down to the built environment.
The strategy promises to do next to nothing for the 25% of us who are currently obese; the ones who will become diabetic, suffer from heart disease and develop cancers and who will cost the health service a fortune and spend so much time in poor health that they might question their willingness to keep living. And remember most of them will be poor and will be kept fat because of their circumstances.
In Belfast today a meeting organised by the All Island Obesity Action Forum discussed an issue I was unaware of; Obesity Stigma. Off course the fuller figure has always been the target of the stand-up but it’s worrying when doctors and others in healthcare have a similar jaundiced view of the corpulent. Evidence is growing that over-weight people are denied access to treatments due to the, often unconscious, bias and stereotyping of their doctor or consultant who think since they won’t look after themselves why should the Health Service. Indeed, many obese people avoid the GP as they feel they are being treated with contempt and disdain. This matter, if widespread needs urgent attention.
Off course refusal of government to regulate because regulation might upset Big Sugar, Big Fast Food or Big Supermarket is just plain cowardly and a major flaw in the strategy. Fat is cheap and High Fructose Corn Syrup (HFCS) is cheaper still and both are packed into processed foods everything from soft-drinks, to burgers, to sausages, to hot-dogs, to ketchup and chilli sauces, even bread baps.
And then there are the supermarkets who refuse to use food labelling that people understand since plain labelling, such as the traffic-light system developed by the Foods Standards Agency, causes people to eat healthier foods. If people eat healthy foods they won’t buy the processed rubbish supermarkets make huge margins on. A fat tax is a way to modify behaviours effectively and yet no commitment in the strategy. A sugar tax yes and, we will see how that pans out in the real world of the lobby groups.
Our obesity strategy has served up a plate of cold platitudes. In its current form it will fail and in 20 years time half of us will have that “Over-30-BMI-Body”, there will be a reversal of the great work done in reducing heart deaths and 20% of us will have type 2 diabetes and some of these will be as young as 12 years.
I am a pharmacist in Belfast.