OBESITY will become a disease of the past thanks to new weight loss medications helping people who struggle most, according to the HSE’s national clinical lead for obesity.
At the Irish Medical Organisation’s annual general meeting in Killarney, Prof Donal O’Shea said ‘eat less, move more’ should not be the treatment plan for people already obese. He compared the future of obesity to serious health conditions that were common when he was a medical student, that are now rare.
“‘Eat less, move more’ is not the treatment for obesity. Get over it,” he said. “Stop thinking it.”
The notion obesity will become a disease of the past is a spark of hope in a sea of negativity that surrounds a modern culture swimming in unhealthy food and sedentary living.
People who have struggled all their adult lives are finally being offered a real opportunity to treat a life-altering disease, with medicines such as semaglutide (Ozempic, Wegovy) being shown in the scientific evidence to facilitate an average body weight loss of 10% to 20%.
These drugs are a game-changer for people living with obesity who can afford them. But they do not address the root cause of the health crisis caused by a toxic food environment.
Their high price means those who are most vulnerable to unhealthy diets and consequent obesity are least likely to be able to access them, stretching the health gap between the haves and have-nots even further.
Excess body weight increases the risk of a range of chronic disease conditions including diabetes, heart disease, osteoarthritis, sleep apnoea and many types of cancer as well as a shortened life expectancy and higher rates of disability. With 60% of the Irish adult population considered overweight, many doctors see the new drugs as the key to resolving a complex and challenging chronic disease.
But the picture is not completely rosy. Side effects include nausea and vomiting. They also come at a cost, the high price of medication added to a healthcare system already buckling under exponential costs in a growing, ageing population. The cost concerns are magnified by the knowledge that medications usually need to be taken long term to prevent weight regain.
The key issue with weight loss drugs is that they do not address the cause of the problem.
Although ‘eat less, move more’ is not an effective strategy to treat obesity, the saturation of the food environment in ultra-processed, calorie-dense food coupled with high levels of inactivity contribute to excessive weight gain and all the associated health impacts that implies.
A healthcare system designed to treat the sick with drugs that are churned out by a multibillion-euro pharmaceutical industry; for illnesses that are caused by a multibillion-euro food industry - is not a reasoned or cost effective approach to the management of an entirely preventable condition.
The emerging evidence of the health impact of ultra- processed food (UPF) is gaining weight with every month that passes. A meta-analysis published in the BMJ in February identified direct links between higher consumption of ultra-processed foods and a greater risk of heart disease related deaths, type 2 diabetes, obesity, wheezing, anxiety, depression, sleep problems and deaths from all causes. Earlier studies found that diets high in UPF were linked to a 44% increased risk of anxiety.
Also alarming is a study tracking about half a million people in England, Scotland and Wales that found the risk of dementia went up by 25% for every 10% increase in UPF intake.
So what is the answer? Can the ultra-processed food market be regulated to prevent the plethora of impacts on health that are linked to persistent and prolonged dietary intake high of these foods?
UK celebrity medical doctor and broadcaster Chris van Tulleken believes it can. That it is time to apply a ‘tobacco control approach’ to the ultra-processed food industry. The author of Ultra-Processed People told the UK House of Lords Committee on Food, Diet and Obesity in February that the ‘predatory behaviours’ of food corporations are strikingly similar to those of the tobacco industry in the past.
“There is absolute unanimity among independent scientists, that as a category of food, ultra-processed food drives negative health outcomes - a euphemism for early death,” he said. Dr van Tullekan recommended that what is needed is a comprehensive regulatory response to the enormous personal and economic cost of diet-related disease.
‘The (personal responsibility) argument is morally, economically, socially, politically and scientifically dead and buried. All policies must entirely remove that from the table as a characteristic. They must draw on the lived experience of affected people. Most importantly, they have to adopt a regulatory position.’
Dr van Tullekan is not calling for bans or taxes on ultra-processed food. Instead, he is calling for tobacco-style warning labels to be made a requirement for all ultra-processed foods. Black octagonal UPF warning labels were introduced recently in a number of South and Central American countries, with a requirement that labels take up at least 5% of packaging surface area.
“If you did that, Coco Pops gets two black octagons,” Dr van Tullekan told the committee. “Nutritional information published on Coco Pops packaging shows it is high in sugar and salt. These are foods you can’t make a health claim on. You can’t say it supports your family’s health. You get rid of the health claims, you get rid of the Coco monkey, you put it on a different shelf.”
In 2011, the Irish Government approved regulations requiring pictorial health warnings on smoked tobacco products effective from February, 2013. This was followed in 2015 by the introduction of plain packaging, requiring packaging to have neutral colouring and no logos, following a similar move in Australia, the UK and France. More recently, in 2023, alcohol labelling was signed into law providing for alcohol products being sold in Ireland to have health information labels.
These regulations will ensure no alcohol can be sold without bearing a warning that informs that public that ‘drinking alcohol causes liver disease’; displays a health symbol on the danger of alcohol consumption when pregnant; and states there is a direct link between alcohol and fatal cancers.
The Irish Government has proven a global leader in challenging the tobacco and alcohol industry to ensure health impacts of their products are advertising clearly on packaging. Is it time to stand up to the food industry and place similar clear-cut health impact messages on ultra-processed foods?
Obesity is a disease caused by an obesogenic food environment that for too long has been dominated by a multinational profit-driven food industry intent on profits.
As the evidence of the direct link between ultra-processed foods, chronic disease and mental illness mounts, access to weight loss drugs must be matched by robust regulation of the obesogenic and health harming impacts of the ultra-processed food industry. Let’s start with labelling.
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